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COPYRIGHT DEPOSIT. 



PHARMACOLOGY 



TYRODE 



PHARMACOLOGY 



ACTION AND USES OF DRUGS 



BY 

MAURICE VEJUX TYRODE, M.D. 

Ex-Instructor of Pharmacology in the Medical School of Harvard University 



§>econ& CUttion 



PHILADELPHIA 

BLAKISTON'S SON & CO. 

1012 WALNUT STREET 
1912 



KS l«7 



Copyright, 191 2, By P. BLAKISTON'S SON & CO. 



"Authority to use for comment the Pharmacopoeia of the United States of America, 
Eighth Decennial Revision, in this volume, has been granted by the Board of Trustees 
of the United States Pharmacopoeial Convention, which Board of Trustees is in no way 
responsible for the accuracy of any translations of the official weights and measures or 
for any statements as to strength of official preparations." 



PRESS OF 

WM. F. FELL COMPANY 

PHILADELPHIA 



gd.A31688 

I 



PREFACE 



As a teacher of Pharmacology, the author was frequently 
asked by his pupils for a small and concise text-book which would 
give the facts essential to an elementary medical student without 
extensive discussions of opposite opinions. 

It has been in an attempt to supply such a work that the 
following pages have been written. Although the volume is 
small, all the standard literature was consulted and carefully 
weighed before being admitted or rejected, and the criterion 
was always to preserve all the essential, known facts regarding 
the action of drugs, but to reject vague and contradictory state- 
ments of no importance which would but confuse the beginner. 

At the end of each group description there is a brief summary 
of the general action; following the latter is a short statement 
concerning the uses and applications, and, lastly there is a con- 
cise description of the different preparations used in medicine 
with their doses. 

The author does not claim for the book that it is an exhaus- 
tive treatise on Pharmacology suitable for advanced students of 
the subject, but that it may be found useful to the ordinary 
medical students and also to the general practitioners who may 
use it to review their medical school instruction. As one of the 
leading pharmaceutical journals suggested in writing a criticism 
on the first edition, this volume might also be serviceable to 
pharmaceutical students for the study of drug action. 

In this second edition the author has attempted to incorporate 
all new facts in pharmacology or in pharmaco-therapy which 
have been developed since the previous edition. Some minor 
changes in group arrangement have also been made. 

In conclusion, the author wishes to reiterate his thanks to the 



VI PREFACE. 

hundreds of workers in pharmacology whose original monographs 
and text-books he has consulted. 

The author is also very grateful to the pharmacologists, stu- 
dents, and others for the kind manner in which they received the 
first edition, and also for valuable criticisms which some kindly 
offered. 



CONTENTS 



INTRODUCTION. 

Page 

Definitions and General Remarks on the Action of Drugs ..... i 

PART I. 

Drugs whose Constitutional Action is in Greater Prominence. 

i. Group of Ether and Chloral 9 

2. Group of Amyl Nitrite 36 

3. Group of Morphine 40 

4. Group of Ammonia 47 

5. Group of Strychnine 50 

6. Group of Picrotoxin 54 

7. Group of Camphor 55 

8. Group of Caffeine 58 

9. Group of Hydrocyanic Acid 62 

10. Group of Carbon Monoxide 65 

n. Group of Atropine 67 

12. Group of Agaric Acid 72 

13. Group of Muscarine and Pilocarpine 73 

14. Group of Physostigmine 79 

15. Group of Cocaine 82 

16. Group of Curare 86 

17. Group of Aconitine 90 

18. Group of Coniine and Sparteine 92 

19. Group of Veratrine 94 

20. Group of Colchicine 97 

21. Group of Emetine and Apomorphine 98 

21a. Subgroup of Sapotoxin and Solanine 100 

22. Group of Ergotoxine 105 

22a. Subgroup of Hydrastine 107 

23. Group of Digitoxin 109 

24. Group of Quinine 116 

25. Group of Acetanilid and Phenol 120 

vii 



Vlll CONTENTS. 

PART II. Page 

Ferments, Secretions and Extracts of Animal Organs. 

i. Group of Digestive Ferments 139 

2. Group of Bile 140 

3. Group of Adrenalin 142 

4. Group of Iodothyrin 144 

5. Hormones 146 

6. Other Animal Extracts 146 

7. Toxines, Antitoxines, Vaccines 147 

8. Artificial Foods 1 50 

PART III. 

Drugs whose Local Action is Most in Evidence. 

A. Skin Irritant 151 

1. Group of Turpentine Oil 153 

2. Group of Mustard Oil 154 

3. Group of Cantharidin 155 

B. Urinary Antiseptics 159 

1. Group of Sandalwood and Cubeb Oils 159 

2. Group of Hexamethylenamin 160 

C. Vegetable Purgatives, Group of 163 

1. Castor Oil Division 166 

2. Aloin and Rhubarb Division 167 

3. Phenolphthalein Division 167 

4. Elaterin and Podophyllin Division. 168 

D. Vegetable Bitters 172 

1. Group of Bitters 172 

E. Vegetable Astringents 175 

1. Group of Tannic Acid 175 

F. Anthelmintics. (Worm Remedies.) 179 

1. Group of Pelletierine 180 

2. Group of Santonin 183 

G. Mechanical Agents 186 

PART IV. 

Drugs of Inorganic Origin. 

A. Oxidizing Agents and Free Halogens 191 

1. Group of Oxygen 192 

2. Group of Free Halogens 196 



CONTENTS. IX 

Page 

B. Water, Acids and Alkalies 200 

1. Group of Water 200 

2. Group of Acids 202 

3. Group of Alkalies 208 

C. Neutral Salts, Group of 214 

D. Non-metallic Elements 233 

1. Group of Phosphorus 233 

2. Group of Sulphur and Sulphides 237 

E. Metallic Compounds 240 

1. Group of Aluminum 241 

2. Group of Copper and Zinc 243 

3. Group of Bismuth 246 

4. Group of Lead 250 

5. Group of Mercury 254 

6. Group of Silver and Gold 260 

7. Group-of Iron 263 

8. Group of Arsenic and Antimony 266 

Index 277 



INTRODUCTION. 



The treatment of disease is as much an inherent part of the 
nature of human beings and of the instinct of self-preservation as 
the taking of nourishment. We see evidence of dietetic, physical 
and also drug therapy even in the lower animals. It is a well- 
known fact that household animals refrain from eating much, or 
indigestible articles when suffering from stomach upsets. Cats 
and dogs when suffering from some gastro-intestinal disturbance 
go into the fields to find grasses with emetic or purgative proper- 
ties. Men in uncivilized conditions all have some sort of crude 
medical knowledge and, like the American Indians, often have 
some " medicine man." The white race has had ups and downs 
in the status of medicafl knowledge. Recent discoveries seem to 
show that the ancient Egyptians, even thousands of years ago, 
had probably as fully a developed medical system as we have, with 
as many if not more specialties. There followed a curve of de- 
cadence which probably reached its lowest period shortly after 
the fall of the Roman Empire. After this the curve then rose 
again with the work of the Arab physicians, followed by that of 
the Christians, until it has again in our days reached a high posi- 
tion. 

We have but little evidence left us of what was the knowledge 
of drugs of the ancients at the time of their maximum medical 
development, but we do know positively that since the first 
centuries of the Christian era, our knowledge has more or less 
steadily increased. 

One great drawback, still existing, which has hindered our 
progress in the knowledge of diseases and their treatment, has been 
shiftless observations and the drawing of unwarranted conclu- 
sions. Thus, with some drugs every conceivable action and cura- 
tive value has been described by some and contradicted by others. 



2 INTRODUCTION. 

At the beginning of the last century, the great French physiolo- 
gist, Magendie, introduced a new and more accurate method of 
studying drugs by applying them to animals where all conditions 
were checked. After him, Claude Bernard and a host of others 
followed this new subject of experimental study of drugs, which 
gave us very valuable information as to many hitherto unknown 
properties of old remedial agents and led to the discovery of 
new ones. Thus, by the experimental method used both on 
animals and man, there have developed all the modern methods of 
anaesthesia, of antisepsis, of treatment by antitoxines and vac- 
cines and the coming field of Therapia sterilisata magna, just be- 
gun by Ehrlich in the substance salvarsan. 

It, however, had become the tendency to draw too generalized 
conclusions from the study of the action of remedial agents on 
certain species of animals in health and to attribute them theo- 
retically to other classes of animals and to diseased conditions. 
This not infrequently led to fallacious results, for although many 
drugs present the same general type of action in various species 
of animals, nevertheless, there are a vast number which present 
radical differences of action. This difference of action also exists 
in the same species under pathological conditions or when other 
drugs are used at the same time. 

In this way it has been shown that epinephrin, which usually 
constricts powerfully the blood vessels in mucous membranes, 
entirely fails to do so if there is any inflammatory reaction present. 
The difference between the action of antipyretics in health and 
disease was shown years ago. They decrease febrile temperature 
and have no effect on normal temperature. It has been found 
that starvation has a marked effect upon the action of drugs. 
With some, their action is increased, while with others, it is much 
diminished. Formerly, caffeine was almost always given with 
acetanilid and other coal tars, with the idea of counteracting the 
depressant effect of the latter by the stimulant effect of the 
former on the heart and respiration. Experimentally, it was 
shown that caffeine not only did not diminish the noxious effect of 
some coal tars but increased them. 



DEFINITIONS. 3 

From what has been said, it is plain that we cannot draw too 
generalized conclusions from experimental work, and that in 
applying drugs in practical medicine, we must bear in mind the 
innumerable conditions which may affect the action of our agents. 
Thus, we still are in the infancy of our knowledge of drugs and 
other therapeutic agents, and we must always remain open to 
changes in our views when new works demolish the old theories. 

The statements which follow are, to a certain degree, dogmatic 
in order to give something definite for the beginner to start with ; 
nevertheless, they should not be regarded as immutable laws. 

Therapeutics is that subject which treats of the methods used 
in curing or alleviating disease. These may be divided into 
four groups; first, dietetic, including qualitative and quantita- 
tive changes in the diet; second, physical and physicochemical, 
including the application of electricity, massage, heat and cold; 
third, suggestive, such as hypnosis; and fourth, medicinal. This 
volume is devoted to the consideration of medicinal agents or drugs. 

A drug is any substance other than a food stuff or a mechanical 
agent, which produces changes in a living organism. 

These changes, constituting the action, may be beneficial or 
harmful depending upon the quantity of the drug used and upon 
the conditions of the organism receiving it. When a drug is 
used in suitable doses to produce beneficial influences, it is said 
to be a medicine. When it is used in such doses as to produce 
harmful effects, it is said to be a poison; e. g., chloral in small 
doses is a valuable medicine to produce sleep, while in larger 
quantities it is a powerful narcotic poison. 

Drugs produce their action in a living organism either by increas- 
ing, decreasing or stopping one or more functions, or in infectious 
diseases, by destroying the parasites or the effect of their noxious 
products. 

When employed in medicine for the treatment of disease, they 
are used according to these principles. 

Thus for too high temperature, we employ antipyretics to re- 
duce it; for excessive secretion of hydrochloric acid and in- 
creased tonic contraction and spasm of the pylorus, we give atro- 



4 GENERAL AND LOCAL ACTION. 

pine, which decreases both. When the heart is abnormally weak, 
we give digitalis to increase its strength, and when the kidneys are 
not excreting a sufficient amount of urine, we stimulate them 
with some of the various diuretics. As examples showing therapy 
directed against the specific cause of disease, we have the use of 
quinine in malaria, mercury and salvarsan in syphilis, diphtheria 
antitoxine in diphtheria, vermicides for intestinal parasites, etc. 

The science which deals with the study of the action of drugs 
is called Pharmacology or Pharmacodynamics. More recently, 
that term has been reserved particularly for the subject which 
treats of the action of drugs on normal animals. For the scientific 
study of drugs upon diseased organism, the name experimental 
therapeutics is now more commonly used. If we consider drugs 
as poisons and study the symptoms which they produce in both 
accidental and intended cases of poisoning and also the methods 
used for their detection, the subject is known as Toxicology, 
and is in part included in pharmacology. 

The action or changes produced in a living organism by drugs, 
may be either of a chemical or of a physicochemical nature. Most 
drugs unite chemically with some constituents of the organism, 
and, by virtue of this union, change its functions. Some, such 
as the neutral salts, act in part through their physical relations 
to the tissues. 

A drug may produce alterations in the functions of a part to 
which it is applied before it has entered the blood circulation. 
These changes may consist of loss of sensation, inflammation, 
with its symptoms, necrosis and astringent effect, and constitute 
local action. The changes produced by a drug after it has been 
absorbed into the circulation, are known as general action. 
Thus after a subcutaneous injection of morphine, its local action 
is irritation at the place of application, while its general action, 
is the production of sleep. 

Intensity of action depends upon many factors besides the 
quality of the drug and the quantity given. It is dependent also 
upon differences in the condition of the subject receiving the same, 
such as its species, race, sex, age, habits, weight, states of nutrition 



ABSORPTION. 5 

and of health and individual susceptibility. A man is much more 
susceptible to morphine than a dog, likewise one species of frogs 
differs from another in this respect. Very young children, old 
persons and females, are more easily affected by medicinal agents 
than vigorous males. As a rule, the heavier the subject, the 
greater is the quantity of a drug which is required to produce a 
certain effect. With some drugs, such as morphine, cocaine and 
alcohol, habituation is a most potent factor in affecting the in- 
tensity of action, e. g., occasionally morphine or cocaine habitues 
may take without any apparent immediate effects several times 
the ordinary fatal dose of these poisons. Some individuals show 
very intense or peculiar symptoms with a quantity of a drug 
which would not produce these in most persons. This suscepti- 
bility is known as idiosyncrasy. 

The intensity of action of a drug depends to a certain extent upon 
its concentration in the blood. The concentration in turn depends 
upon the difference between the rate of absorption and excretion. 
Hence, the more rapid the absorption and the slower the excre- 
tion, the greater is the concentration when other conditions are 
equal. The reverse is also true. Such an active drug as curare, 
the Indian arrow poison, produces no effect whatever when given 
by the mouth, because it is so slowly absorbed by the gastroin- 
testinal tract, and so rapidly excreted by the kidneys, that there is 
never a sufficient concentration in the blood to cause any action. 
When either excretion is stopped by tying the renal arteries, or 
when the absorption is made more rapid by giving this drug under 
the skin, or into the blood vessels, it causes severe symptoms. 

The rate of absorption depends to a certain extent upon the 
physical characters of the drug, such as volatility, diffusibility and 
solubility in water, and it is promoted by all these factors. Of im- 
portance on the part of the organism is the place of application and 
the efficiency of the circulation. Thus drugs are most rapidly ab- 
sorbed from serous surfaces such as those of pleura and peritoneum. 
The next most efficient absorbing surfaces are the subcutaneous tissues. 
Drugs are most slowly absorbed from the mucous membranes of the 
gastro-intestinal tract. A good blood circulation is essential to 



6 EXCRETION AND MATERIA MEDIC A. 

good absorption, for, in heart diseases when the circulation is very 
inadequate and oedema is present, a drug may not be absorbed 
easily from serous membranes or subcutaneous tissues. 

Excretion, like absorption, is usually more rapid with volatile 
and diffusible substances and with those soluble in water. The 
rule is not absolute, for even though the salts of the sodium 
sulphate group and also some sapotoxins are soluble in water, yet 
they are absorbed with difficulty, and on the other hand, many 
metals, as copper, lead and iron, even when taken in the form of 
very soluble salts, form compounds with the proteids of the tis- 
sues which are tenaciously retained by the organism, making 
excretion very difficult. This all tends to show that the specific 
chemical nature and affinity of drugs is of very great importance 
in relation to absorption, excretion and action. 

Drugs are excreted either unchanged, or after chemical combina- 
tion with some products of the organism, or after oxidation to simpler 
compounds. For example, ether is excreted unchanged, chloral 
is in part combined with glycuronic acid, and is excreted as 
urochloralic acid. Alcohol is in most part oxidized to, and 
excreted as, carbon dioxide and water. 

Excretion may take place through the kidneys, intestines, stom- 
ach, liver, salivary glands, lungs, skin, etc. Most drugs have 
a selective preference for one channel or another, e. g., morphine 
is excreted almost exclusively by the stomach and intestines, 
while strychnine is excreted by the kidneys, and ether by the 
lungs. 

Subordinate to the study of the action of drugs, is the study 
of their physical and chemical properties. The division treat- 
ing of these is known as Materia Medica. It includes the sub- 
jects of Pharmacy, or the art of compounding drugs, that of 
Pharmacognosy, or the study of the methods used in the recogni- 
tion of drugs, that of Posology, or the study of doses, and lastly, 
the study of prescription writing. 

A large percentage, but not all drugs are described in an official 
book called "Pharmacopeia" in most countries and " Codex" in 
France. These ''Pharmacopeias" of different countries differ 



MATERIA MEDIC A. 7 

from each other considerably in the choice of drugs and prepara- 
tions and also in the strength of these. During the past few- 
years, greater efforts have been made to reach greater unity. 

In the following pages our attention will be occupied mainly 
with the action and uses of drugs. There will also be given a 
very brief notice of the physical and chemical characteristics 
and doses. 

The drugs are divided into groups, which are composed of 
members having the same or nearly the same general pharma- 
cological action. The first group consists of drugs whose char- 
acteristic action is a depression of the brain. 



PHARMACOLOGY. 



PART I 



GROUP OF ETHER AND CHLORAL. 

This group contains a series of drugs whose chief action is the 
production of narcosis. It includes most of the fluid and 
volatile hydrocarbons, alcohols, ethers, neutral esters, aldehydes 
and ketones of the aliphatic series; also, their halogen derivatives. 

The physical properties of the members of this group influence 
to a considerable degree their intensity of action. As a rule, the 
more volatile are the most active while the solid nonvolatile, 
which are insoluble in water, are the least active. Thus of the 
hydrocarbons, the very volatile pental is very active while the 
nonvolatile and insoluble parafTme is absolutely inert. 

The very volatile compounds are absorbed by the lungs in the 
form of vapors in sufficient quantities to produce complete pa- 
ralysis of the brain. Their intensity of action can be easily regu- 
lated when administered by these channels while very intense 
depression of the brain for a short time can be produced. Thus 
the very volatile compounds are ideally suited to produce uncon- 
sciousness during surgical operations and are called anaesthetics. 
The solid nonvolatile members are more appropriately admin- 
istered by the gastro-intestinal tract, and their absorption and 
excretion are slower; therefore their effects come on more slowly 
and less intensely but last a longer time. They are more suitable 
when we wish to produce a mild depression of the cerebrum to 
induce sleep, and are called hypnotics or soporifics. 

9 



IO CONSTITUTIONAL ORGANIC DRUGS. 

The anaesthetics and hypnotics do not differ markedly from each 
other in their quality of action, but only in their clinical applica- 
tion on account of their difference in physical properties. Small 
quantities of the anaesthetics may produce simple sleep, while 
large doses of hypnotics may give rise to complete unconscious- 
ness or anaesthesia. The sleep produced by the former is of too 
short duration to be of practical use, while the anaesthesia pro- 
duced by the latter cannot be properly regulated. 

The question as to how narcotics produce their effect has 
been one of the most discussed in the field of pharmacology. 
Wild theories have been advanced in the past, such as, that nar- 
cosis is due to vagus inhibition; or to changes in the blood pre- 
venting the latter from nourishing the brain, or to semi-coagu- 
lation of nerve cells. More recently the theory of solubility and 
affinity of lipoid substances of the brain cells towards narcotics has 
been advanced by Myer and Overton and has held ground among 
many pharmacologists for the last ten years. It presupposes that 
narcotics produce their action varying in intensity according to 
their power of dissolving fat-like substances, and therefore the 
lecithin and Cholestin from the nerve cells, and that this suspends 
the activity of the latter. This theory is not unattackable, since 
there are many substances, especially benzol derivatives, whose 
affinity for fats is greater than for water, and yet which do not 
produce narcosis. 

It is probably true that the greater solubility in fatty substances 
than in water, aids the penetration of the narcotics into the nerve 
cells, but the action is probably due to specific combination of the 
narcotic with some essential molecule of the cell whose function is 
suspended when this happens. In support of such a combination 
it has been found that the amount of chloroform present in an 
anaesthetized animal was much greater in the brain than in cer- 
tain of the tissues, as the muscles, etc. The firmness of the com- 
bination of anaesthetic with brain tissue depends upon the partial 
pressure of the drug. When the amount of an anaesthetic is de- 
creased in the blood by allowing free respiration without the in- 
troduction of more of the narcotic, the combination breaks up in 



GROUP OF ETHER AND CHLORAL. II 

the nerve cells affected, the cells regain their functional activity 
and the individual regains consciousness. 

The action of most narcotics on the central nervous system 
consists of a successive depression of the cerebrum, spinal cord, 
and lastly, of the medulla. The first effect on the cerebrum is a 
decrease in the sensibility to external stimuli not of a painful 
character, also, a dulling of the intellect and a decrease in volun- 
tary movements. On account of the lowering of judgment and of 
other higher psychical functions, great talkativeness and excite- 
ment may be observed, especially when the surroundings and 
mental conditions of the subject are appropriate. Then, follows 
complete paralysis of the cerebrum with unconsciousness and 
loss of the sensation of pain, also, paralysis of the cord with abo- 
lition of reflexes, and muscular relaxation. At last the medulla 
is paralyzed, and there is stoppage of respiration and fall of 
blood pressure, due to the depression of the respiratory and vaso- 
motor centres. The stage in which complete unconsciousness is 
present and muscular movements are suspended, is that called 
surgical anaesthesia. The last one, with paralysis of the medulla, 
is the fatal stage. 

The vasomotors supplying the smaller vessels of the skin and 
surface of the brain are paralyzed at the beginning of the action 
of the narcotics. The reddening of the face and body observed 
after a few glasses of wine, is also present at the beginning of 
anaesthesia with ether or chloroform. Because of the decrease of 
muscular movements, the production of heat is diminished, but 
on account of the dilatation of the superficial blood vessels, the 
loss of the bodily heat is increased and the temperature of the 
organism may be lowered several degrees. During prolonged 
surgical anaesthesia, if the patient is not properly protected, the 
loss of heat may be sufficient to increase the collapse from other 
causes. 

ETHER or Ethyl Ether which is easily volatilized is a typical 
anaesthetic. It was the first discovered and has been, to the pres- 
ent time, the most extensively used in this country. Its typical 
action may be seen after direct introduction into the blood streams 



12 CONSTITUTIONAL ORGANIC DRUGS. 

or after administration through any one of the channels of ab- 
sorption, as the subcutaneous tissues, gastro-intestinal tract, 
rectum and lungs. The latter channel has been found to be 
preferable because the absorption and excretion can be more easily 
regulated and the irritation is less than by most of the others. 

Except for a very small amount which passes out by the kid- 
neys, ether is almost entirely excreted by the lungs. The small 
percentage excreted by the kidneys produces at times marked 
irritation of these organs. After prolonged etherization, besides 
evidences of renal irritation, the urine may contain glycuronic 
acid, glucose, acetone and diacetic acid. These are probably 
the result of a disturbance in the metabolism. 

Since the most appropriate channel for the administration of 
ether is the lungs, the study of the conditions influencing its ab- 
sorption through these organs is of great importance. 

Its absorption and excretion by the lungs are subject to the 
physical laws of partial tension of gases. The walls of the alveoli 
of the lungs act as a permeable membrane between the air in the 
alveoli on the one side, and the blood on the other. According to 
the law of partial tension, the volume per cent, of ether on both 
sides of the alveolar wall will have a tendency to become equal 
when ether is administered as a vapor to the lungs. If, for in- 
stance, the blood contains five per cent, ether and the air in the 
alveoli three per cent., ether will be excreted into the alveoli until 
both the blood and the air in the latter contain the same percent- 
age. If, however, the blood contains less ether than the alveolar 
air, the blood will then absorb ether until it contains the same per- 
centage as the air of the alveoli. The concentration of ether in 
the blood, and therefore, the intensity of action at a given time, is 
governed not by the absolute quantity administered, but by the 
percentage contained in the air of inspiration. The air of inspira- 
tion must contain six per cent, in order to produce complete loss of 
consciousness and insensibility to pain in human beings. Air 
containing over this percentage tends to paralyze the respiratory 
centre. When failure of respiration occurs from an overdose of 
ether, it may be overcome by stopping the administration of this 



GROUP OF ETHER AND CHLORAL. 1 3 

drug and by applying artificial respiration. These measures 
favor the excretion and thus lower the concentration in the 
blood. 

When ether is administered slowly by inhalation, its action on 
the central nervous system may be divided into four stages; 
in the first, there is a primary decrease of consciousness accom- 
panied by a feeling of asphyxia and ringing in the ears; in the second, 
the controlling centres in the cerebrum are depressed and there is 
incoordination of movements and speech which may amount to 
violent struggling and shouting; in the third, or the stage of sur- 
gical anaesthesia, the whole cerebrum and cord are paralyzed, sensa- 
tion to pain is lost, and there is complete unconsciousness and 
muscular relaxation; in the fourth, the medulla becomes paral- 
yzed, and asphyxia and weakened circulation ensue. Death takes 
place in this stage from paralysis of the respiratory centre. 

The heart is never directly stimulated by ether. The increase 
in pulse rate seen at the beginning of anaesthesia is purely a re- 
flex phenomenon, due to irritation of the air passages by the 
ether vapors, yet, in the course of ordinary anaesthesia, the 
blood pressure is not as a rule much decreased. Poisonous doses 
produce a marked fall of blood pressure by depressing the vaso- 
motor centres and the heart itself; while smaller doses at the 
beginning of anaesthesia, may produce a short and insignificant 
rise of blood pressure, due probably to a reflex stimulation of the 
centre. Concentrated ether vapors may paralyze the heart at 
the beginning of anaesthesia before the drug has had time to reach 
the central nervous system. Under these circumstances, the 
circulation may, at times, be restored by violently compressing 
the thorax with the object of squeezing out the poisonous blood 
from the heart and mechanically stimulating this organ. 

The blood is undoubtedly affected by ether, as the red blood 
corpuscles become destroyed. After a prolonged anaesthesia, a 
considerable degree of anemia may be observed by a direct blood 
count. Nicloux made quantitative determinations of ether in 
the blood under various stages of narcosis. He found that under 
light anaesthesia, the blood contained about one hundred mgs. 



14 CONSTITUTIONAL ORGANIC DRUGS. 

per ioo ex., in deep anaesthesia about 130 mgs., while fatal re- 
sults were obtained when 160 mgs. per 100 c.c. were present. 
The bactericidal and phagocytic action of the blood have been 
found very much reduced by etherization, even more so than by 
chloroformization. 

Marked diuretic effect has been found after from 30 minutes 
to 4^ hours' etherization. This was greater the longer the ether 
was administered. It is probably due to a local stimulant effect 
upon the kidney. This stimulant action may become so great 
as to cause actual inflammation of the kidneys or to increase 
nephritis if already present. 

The pupils are somewhat dilated during the stages of primary 
decrease of sensibility and of excitement. They are contracted 
during complete anaesthesia. Then, they dilate again, either 
when paralysis of respiration and circulation occurs, or when con- 
sciousness returns. 

Owing to the great diffusibility of ether, it easily penetrates 
the skin and mucous membranes, and causes local irritation; 
when its evaporation is prevented, it even produces blisters. 
When administered by inhalation, it gives rise to irritation of the 
mucous membranes of the respiratory tract which leads to in- 
creased salivary and bronchial secretion. Sometimes, especially 
after prolonged anaesthesia, the inflammation of the lungs may 
result in pneumonia. The ether which is swallowed produces 
irritation of the stomach, causing vomiting, and the intensity 
of the gastritis may be great enough to give rise to bloody emesis. 
The irritation in the nose of the terminations of the trigeminus, 
and in the throat of the superior laryngeal nerves, may lead to 
reflex arrest of the circulation and respiration. On the other hand, 
subcutaneous injection of ether, as of any irritant substance, 
may bring about a reflex stimulation of respiration and circula- 
tion, but such stimulation is always of a very transient charac- 
ter. When ether is allowed to evaporate upon the skin, it pro- 
duces cold and local anaesthesia. 

Ether does not affect the contractile power of the parturient 
uterus in moderate anaesthesia, but in deeper stages, when very 



GROUP OF ETHER AND CHLORAL. 1 5 

prolonged, the uterine contractions may become markedly 
diminished. There is probably no effect upon the fetus except 
when very large quantities of ether have been given. 

CHLOROFORM, which was introduced as a substitute for 
ether, resembles the latter in its action, but it is about three to 
four times more powerful and produces general anaesthesia much 
more quickly. Like the other members of this group which con- 
tain halogens, it is much more depressant to the heart, and is more 
likely to cause a sudden arrest of this organ when too concentrated 
vapors are given. Its toxicity on the frog's heart is thirty-six 
times greater than that of ether. 

The central nervous system is affected in the same order by 
chloroform as by ether, but more intensely by the former, so that 
anaesthesia is obtained more rapidly and with less chloroform. 
The stage of excitement is apt to be less marked and often to be 
absent. 

The circulation is much more seriously affected by chloroform 
than by ether. Weakening of the heart is markedly present even 
in the stage of surgical anaesthesia and the blood pressure is 
considerably lowered throughout an ordinary chloroform narcosis. 
This is partly due to a lowered efficiency of the heart itself, but 
also to a dilatation of the blood vessels due to a direct paralysis 
of the smooth muscle fibres within their walls . Thus vaso-dilatation 
is not as with ether due to depression of the vasomotor centres. 

Another very important action of chloroform upon the heart 
is the stimulation of the inhibitory centres which may cause 
a temporary or even permanent stoppage of the heart-beat, 
especially when this organ has been weakened by chloroform. 
Fatal results from this source may occur at the very beginning of 
anaesthesia. 

The body temperature is markedly lowered, sometimes even 
for many hours after the administration of chloroform has been 
discontinued, and this fall is due not only to the increased heat 
expenditure through the skin, but also to the decreased heat pro- 
duction caused by the diminution of the muscular movements 
and of the oxidative processes of the body. 



1 6 CONSTITUTIONAL ORGANIC DRUGS. 

Chloroform is in a sense a protoplasmic poison, as it inter- 
feres with the action of many organized and unorganized ferments, 
and therefore acts as an antiseptic. On account of this toxic 
effect, it causes fatty degenerations of some parenchymatous 
organs, as the liver and kidneys. Such effects are sometimes 
seen after prolonged surgical anaesthesia and may simulate 
yellow atrophy of the liver. Several cases have even proved 
fatal. 

The red blood corpuscles have a particular attraction for 
chloroform and it has been shown that during chloroform anaes- 
thesia the reds contained much more chloroform than the plasma. 
This drug has a well marked hemolytic action both in vivo and in 
vitro and is capable of producing a considerable degree of anemia. 

The elimination of chloroform follows the same order as that 
of ether, i. e., chiefly by the lungs and a small percentage by the 
kidneys, but Nicloux has found that a certain small percentage 
was oxidized in the living body. Small quantities of chloroform 
have been found in the perspiration and in the milk. 

The local irritant action of chloroform is a little greater than 
that of ether, but during or after anaesthesia it is much less evi- 
dent, as smaller quantities are necessary for an equivalent nar- 
cotic effect. Thus, there is much less salivation and rarely 
postnarcotic vomiting. For the same reason, the kidneys are not 
so liable to irritation during short chloroform anaesthesia. 

ETHYL BROMIDE induces anaesthesia very rapidly, and re- 
turn to consciousness is also very speedy, much more so than with 
ether or chloroform. Ethyl bromide differs in its action from 
ether and chloroform in that it paralyzes the sensation of pain be- 
fore the production of complete unconsciousness, but the respirations 
stop from paralysis of the respiratory centre at the same time that 
the loss of the reflexes and muscular ^relaxation occur. The heart 
and the walls of the blood vessels are less depressed than by chloro- 
form. Occasionally in human beings, after apparent recovery 
from ethyl bromide narcosis, a condition of severe and even fatal 
collapse may suddenly arise. This condition may be reproduced 
artificially in animals and is probably due to the formation of a 



GROUP OF ETHER AND CHLORAL. 1 7 

more toxic decomposition product. The substance ethylene 
bromide, with which ethyl bromide should not be confounded, is 
exceedingly toxic and produces just such collapse as is observed 
at times after ethyl bromide. 

ETHYL CHLORIDE, like ethyl bromide, is an exceedingly 
rapidly acting anaesthetic, as unconsciousness may be produced 
from its inhalation in 2 to 3 minutes. This rapidity of action is 
probably due to its great volatility, as it boils at 1 2 C. Recovery 
is also exceedingly rapid. It produces no general excitement and 
is very pleasant to inhale. It is much less poisonous to the heart 
than chloroform. 

PENTAL is also a rapidly acting anaesthetic and produces com- 
plete unconsciousness some time before muscular relaxation 
occurs. It may produce marked muscular spasm, tremors and 
convulsions. It does not seem to have a marked depressant 
effect upon the heart, yet numerous accidents have occurred 
during its use clinically. 

MIXTURES OF ANESTHETICS have been used for many 
years, mainly on the principle that they might be more active 
and safer than the single anaesthetics. The first proposition has 
been borne out experimentally by Honigmann and more recently 
by Madelung. It has been found that the sum total of the action 
of two volatile anaesthetics was greater than the arithmetical 
addition. As regards safety, the mixtures have been a total 
failure because they introduce a great degree of uncertainty on 
account of the constant change of the mixture through the 
different boiling points of their elements. One of the most famous 
of these mixtures has been the British A.C.E., containing alcohol 
one, ether two, and chloroform three parts by volume. Another is 
Schleich's mixture which contains ether, chloroform and petroleum. 

NITROUS OXIDE, although not related chemically to this 
group, is most appropriately described here on account of its 
pharmacological action, which closely resembles that of the ether 
series. 

When it is inhaled mixed with air at the normal atmospheric 
pressure, it produces flushing of the face, hilarity, for which it was 



1 8 CONSTITUTIONAL ORGANIC DRUGS. 

called laughing gas, unsteady gait and incoordination of thoughts 
and movements, just as in drunkenness or in the first stages of 
ether narcosis. Complete ancesthesia does not take place un- 
less the atmospheric pressure is raised or unless it be given in the 
absence of air, because otherwise the concentration in the blood 
is not sufficient for maximum effect. 

When pure nitrous oxide is inhaled without admixture of 
air, the patient passes rapidly through the symptoms just de- 
scribed, then becomes unconscious, and after deep cyanosis, 
dyspnceic and stertorous breathing, the respirations cease before 
the circulation. 

Nitrous oxide undiluted with air, produces ancesthesia somewhat 
similar to that obtained by ether. Unlike the latter, it produces a 
rise of blood pressure which is due to asphyxia as it does not occur 
when air is given with it. Excepting that it does not give rise to 
convulsive movements, it causes the same respiratory phenome- 
non which is seen in asphyxia. It produces: first, a stage of violent 
inspirations; second, one of violent expirations; third, a few in- 
spiratory movements ending in paralysis of respiration. 

Anaesthesia is obtained in one minute during the second stage 
of the respiratory phenomenon. It lasts about one minute after 
the administration of the gas is discontinued. The subject can 
be revived by artificial respiration even at the beginning of the 
third stage of the respiratory changes. This fact makes nitrous 
oxide one of the safest of the general anaesthetics. 

When nitrous oxide is given diluted with twenty per cent, of oxygen, 
but under one and one-quarter of an atmosphere pressure, com- 
plete ancesthesia can be obtained and maintained for hours without 
any ill effects. This demonstrates that nitrous oxide has specific 
narcotic properties like ether or chloroform and that the anaes- 
thesia produced by it is not due wholly to asphyxia. When it is 
administered in the absence of air, as it is usually employed, there 
is little doubt then, that the narcosis is due to both specific 
narcotic properties and to beginning asphyxia, because a very 
small quantity of air is sufficient to prevent complete anaesthesia. 

CHLORAL has almost the same pharmacological action as 



GROUP OF ETHER AND CHLORAL. 1 9 

chloroform so that it was formerly, but wrongly, thought to be 
decomposed into the latter in the body. It acts as chloral and 
is excreted in the urine in part combined with glycuronic acid 
as urochloric acid. Chloral, like the other solids of this group, 
is less readily absorbed and excreted than chloroform. There- 
fore, it acts more slowly and for a longer time. On this account 
the first stage of narcosis, i. e., depression of the cerebrum with 
drowsiness and sleep, can be more easily maintained. However, 
larger doses produce complete unconsciousness, loss of reflexes, 
paralysis of respiration and fall of blood pressure, the same as does 
ether and chloroform. 

Moderate doses of chloral produce a condition closely resembling 
normal sleep. The respiration and pulse are slightly slowed 
and the subject can be awakened by external irritation, as in 
natural slumber. If the individual is in pain or if the reflexes 
are greatly exaggerated, very large doses are required to bring 
about the somnifacient action of chloral, and this is to be ex- 
plained by the fact that the latter, like the other members of this 
group, paralyzes first the higher faculties of the brain and only later 
the centres governing pain and the reflex irritability of the cord. 

After having taken an ordinary medicinal dose of chloral a 
patient may wake in from 5 to 8 hours feeling well and refreshed, 
just as after normal sleep, but sometimes he may suffer from 
giddiness, vertigo, confusion and headache. After larger doses, 
as from 4 to 6 grams, the patient falls into a comatose sleep from 
which he can hardly be aroused, where the reflexes are much 
diminished and where a condition approaching anaesthesia is 
present. After such doses there is almost always present head- 
aches, confusion, giddiness, nausea, and vomiting. 

Chloral does not paralyze the sensation of pain as does mor- 
phine in medicinal doses. Sleep may even be completely pre- 
vented by the presence of pain. 

The efficiency of the circulation is markedly affected by chlo- 
ral. The blood pressure is lowered by depression of both the vaso- 
motor system and of the motor ganglia in the heart. The dilatation 
of the peripheral blood vessels results both from the central ac- 



20 CONSTITUTIONAL ORGANIC DRUGS. 

tion and also from a local effect on the vessel walls. In conse- 
quence of these facts, chloral should be used with great caution 
when the circulation is previously depressed. 

The body temperature is decreased on account of the dila- 
tation of the superficial blood vessels, and from an action on the 
heat regulating centres in the medulla. 

The effects of chloral on the metabolism correspond very 
closely to those of chloroform. An augmented destruction of 
proteids with imperfect oxidation is suggested by the fatty degen- 
eration of various organs, seen after prolonged chloral adminis- 
tration, and also by the increased elimination of nitrogen, phos- 
phates and sulphates. 

When chloral is taken in increasing doses over a period of time, 
a habit is contracted just as with morphine, cocaine and alcohol, 
and the sufferer shows the same general depression, cachexia, 
digestive disturbances, diminution of mental powers and skin 
eruptions which are observed in morphine fiends. 

Local irritation is a well-marked symptom of chloral on the 
mucous membrane. It is very apt to produce nausea and vomit- 
ing from irritation of the gastric mucosa. For this reason it 
should always be administered well diluted. Besides the irritant 
action, it also has a mild local anaesthetic effect which is some- 
times made use of by skin specialists. 

The various chloral derivatives, chloralformamide, chloral- 
ose, chloretone, hypnal, dormiol, ural, somnal, also butyl chloral 
and isopral, have an action resembling, to a certain extent, that 
of chloral. 

SULPHONAL, or sulphonmethane, has an action on the central 
nervous system, similar to, but less intense than chloral. In small 
doses it does not depress respiration and circulation as much 
as the latter, but it is very apt to produce irritation of the kidneys, 
through which it is excreted partly changed to ethylsulphonic 
acid. After prolonged use, especially in weak subjects, it may 
cause haematoporphyrinuria, headache, ringing in the ears, nausea, 
vomiting, weakness, suppression of the urine, skin rashes, dis- 
turbances of cerebration and gait, and even collapse and death. 



GROUP OF ETHER AND CHLORAL. 21 

Although the milder untoward symptoms are not very infre- 
quent, fatal results seldom occur. 

Sulphonal being very insoluble in water is exceedingly diffi- 
cult of absorption, so that its action may not be seen for a great 
many hours after administration. For instance, this drug given 
at night for sleeplessness, may not produce sleep until the next 
day, and since it is very slowly excreted, its effect may last 
throughout that day. 

TRIONAL, or sulphonethylmethane, and TETRONAL, re- 
semble sulphonal in their chemical structure, action and uses. 
Trional acts somewhat more rapidly than sulphonal because it is 
more soluble in water and more readily absorbed. It is also less 
likely to produce disagreeable symptoms, although haematopor- 
phyrinuria may result from both trional and tetronal. 

PARALDEHYDE possesses the general narcotic action of 
chloral, but it is much less depressant to the respiration and cir- 
culation: on the other hand it is less efficient in producing sleep. 
It is excreted mainly by the urine, but also in part by the breath, 
to which it gives a disagreeable odor. Patients frequently object 
to paraldehyde on account of its peculiar smell and taste, and 
these may be sufficient to counterbalance the narcotic effect of the 
drug. It is usually a very safe hypnotic, and from 50 to 100 G. 
have been taken without fatal results, although the medicinal dose 
is about 3 G. 

AMYLENE HYDRATE, or dimethylethylcarbinol, is a more 
powerful hypnotic, but has a greater depressant action on the 
heart and respiration than paraldehyde, although it does not have 
as much depressant effect as chloral. In dogs and cats, it pro- 
duces considerable excitement which may result in convulsions. 

URETHANE, or ethyl carbamate, has also a mild hypnotic 
action. It does not depress respiration and circulation, but even 
stimulates these in small medicinal doses, and for this reason it 
would be almost a perfect hypnotic if, in some subjects, it did not 
entirely fail to produce sleep. It is oxidized in the body to urea. 

VERONAL, although related chemically to urethane, is much 
more powerful. It may produce poisonous effects from depres- 



22 CONSTITUTIONAL ORGANIC DRUGS. 

sion of the respiration and circulation, which in a few cases have 
resulted in death from collapse; nevertheless, in small doses it has 
been found very useful as a soporific. 

HEDONAL, another urethane derivative, has quite good nar- 
cotic properties and is not so depressant to the vital centres as 
veronal. 

BROMURAL, a new derivative of urea, has recently been intro- 
duced with claims of being both a nerve sedative and somnifa- 
cient. A number of authors find that its effect as a sleep pro- 
ducer is much less marked than as a sedative. 

ADALIN acts very much like bromural and is more valuable 
as a sedative than as a hypnotic. It is said not to produce any 
by-effects or any unpleasant action upon the heart or respiration 
when given in smaller doses. 

ISOPRALhas been recently introduced as a narcotic by Impens, 
as being free from untoward effects and much more active than 
chloral as a narcotic. Others, however, have found it dangerous 
in some cases and as possessing a number of untoward effects, such 
as headaches, dizziness, weakness of the limbs, vomiting and skin 
eruptions. 

NEURONAL has been warmly recommended by some as a nar- 
cotic with a claim that the sleep was obtained rapidly, was of a 
restful character and that the waking was unattended by un- 
pleasant symptoms. Nevertheless, numerous other authors have 
found it to possess marked untoward effects, as burning in the 
stomach, dizziness and headaches, nausea, vomiting and skin 
eruptions. 

BORNYVAL, GYNOVAL and BROVALOL are preparations 
of valerianic acid which have been highly recommended recently 
by their manufacturers as nerve sedatives. Their action is very 
uncertain, and being volatile oil compounds, their effect is very 
irritant to the mucous membrane of the stomach and they have 
not found favor in the author's hands. 

ETHYL ALCOHOL exerts the same effects as ether on the 
central nervous system and circulation, but with very much larger 
doses. It causes the same local irritant action. It differs essen- 



GROUP OF ETHER AND CHLORAL. 23 

tidily from ether in being burnt in the body to carbon dioxide and 
water. It, therefore, produces heat and energy and can replace a 
certain amount of carbohydrates and fats in the diet. 

On account of the very extensive use of alcohol as a beverage 
and as an intoxicant, great attention has been given to its pharma- 
cological action. Very varied opinions have been expressed 
concerning its utility and effects on the animal organism. One 
erroneous statement made concerning alcohol is that it is a stimu- 
lant to the central nervous system and circulation, for, direct ex- 
periments have never shown any absolute increase in the efficiency 
of these functions. The excitement seen after a few glasses of 
wine, is the result of paralysis of the coordinating centres, re- 
sembling that observed in the first stages of etherization. The 
greater fluency of speech and assurance in speaking is due to the 
blunting of the judgment and fear, and not to a stimulation of 
the intellect, because words are frequently misused and expres- 
sions ill chosen. In a few instances, when a man is said to do 
better mental work under the influence of alcohol, it is probable 
that he has such an excellent intellect that he is accomplishing 
it rather in spite of this drug. 

The special senses are also depressed so that the vision, hearing, 
taste, smell and touch are all decreased in sharpness of perception. 
The sense of pain is also numbed and the lack of sensibility to 
external injuries seen in drunkards, is a testimony to this fact. 

Although, after a few glasses of whiskey one may occasionally 
feel more energetic, still the absolute capacity for muscular 
work is much decreased, fatigue comes on sooner, and recovery 
from the exhaustion is slower. Direct experiments on the isolated 
frog's muscles also show a decrease in muscular force. In the 
training of athletes, it is generally admitted that exclusion of 
alcohol gives better results, and this fact explains the success of 
Americans in international matches, because they especially 
train without intoxicants. 

The heart is never directly stimulated by alcohol; on the con- 
trary, large doses paralyze its action. This effect can be shown 
both on the intact animal and on the isolated apex. In the iso- 



24 CONSTITUTIONAL ORGANIC DRUGS. 

lated frog's heart it has been found that alcohol is one hundred 
and ninety-two times less toxic than chloroform. An increase 
in pulse rate is usually observed after a few drinks, but this is 
chiefly the result of the excitable surroundings, and also, to a 
smaller extent, of a reflex stimulation from the local irritant effect. 

With sufficient quantities the vasomotor centres are de- 
pressed, the larger blood vessels are dilated and the blood pres- 
sure falls, but very small doses are sufficient to dilate the per- 
ipheral vessels. This gives the well-known alcoholic reddening of 
the face and the sensation of warmth. The internal body tem- 
perature is reduced, especially when that of the external sur- 
roundings is very low. As a precaution, people in Arctic regions 
do not drink alcoholic beverages before exposure to cold, for fear 
of freezing to death. 

A small quantity of alcohol taken internally or injected sub- 
cutaneously, usually increases, for a short time, the rate and full- 
ness of the respirations. This is purely a reflex phenomenon, 
as the only direct action of alcohol on respiration is a depressant 
one. 

Contradictory opinions have been expressed on the action of 
alcohol on digestion. The truth is that alcoholic beverages 
usually increase appetite on account of their pleasant taste and 
local irritant effect on the mouth and stomach. In concentration 
not sufficient to produce inflammatory reaction, alcohol stimulates 
the secretion of the digestive juices, and when it is diluted enough, 
it does not decrease the efficiency of the ferments. In concen- 
tration of over ten per cent., it retards the action of pepsin. The 
local stimulation also improves the motor activity of the gastro- 
intestinal tract: this explains the relief of after-dinner fullness 
by a small glass of brandy. 

Alcohol has a very marked action on the metabolism depend- 
ing on several factors, one of these being the fact that it is oxi- 
dized in the living organism to carbon dioxide and water. For 
instance, when not more than one hundred grammes are given 
daily to a man, it is all burnt except two per cent, which is found 
in the urine. Because of its presence in the urine, it markedly 



GROUP OF ETHER AND CHLORAL. 25 

increases diuresis. The oxidation, however, takes place rather 
slowly. Just as with some other oxidizable substances, the power of 
an organism for burning alcohol may be increased by habit, so that 
habitual drinkers can take much larger quantities with less action 
than those not accustomed to its use. 

As might be expected, on account of its combustion in the body, 
alcohol can replace carbohydrate and fats in the diet in isodynamic 
amounts ; so seven grammes of alcohol are practically equivalent 
to four and one-tenth grammes of carbohydrate or nine and three- 
tenths grammes of fat. This is only true when moderate doses are 
used and when the individual is accustomed to alcohol. Under 
such circumstances the proteids are also spared and the amount 
of nitrogen in the urine is diminished. 

When large toxic doses are used, or when it is first given to an 
individual not habituated to it, an increase in the proteid destruc- 
tion takes place as shown by a great increase in the nitrogen ex- 
creted in the urine. This is due to its poisonous effects on the 
cellular protoplasm. This action can be seen on unicellular 
organisms just as with chloroform, which fact makes both these 
substances antiseptics. 

Alcohol, however, is much weaker in its antiseptic power than 
chloroform, as many bacteria may grow abundantly in a 4 per 
cent, solution. Concentrated alcohol, or at least of the strength 
from 60 to 70 per cent., is strongly antiseptic. 

Acute poisoning by alcohol presents practically the same 
picture as the intense action of any of the members of this series, 
as ether, chloroform or chloral; i. e., the symptoms are those of 
gradually increasing narcosis which ends in paralysis of the respira- 
tion and circulation. As mentioned above, the depressant action 
of alcohol on the heart is much less than that of chloroform, so 
that, unless there are some previously existing pathological con- 
ditions in the heart, death usually results from paralysis of the 
respiratory centre before the heart is stopped. 

Death from acute alcoholism is infrequent, and the chronic 
abuse is a much more alarming factor in civilization. The 
chronic effects of alcohol are seen in the form of connective tissue 



26 CONSTITUTIONAL ORGANIC DRUGS. 

formation and degenerations of different organs. The irritation 
produces, in the throat, chronic pharyngitis; in the stomach, 
chronic atrophic gastritis. A large percentage of the alcohol in- 
gested reaches the liver and this organ suffers in alcoholics from a 
degeneration with connective tissue proliferation called cirrho- 
sis. The intellect frequently suffers because of a similar change 
in the brain leading to the formation of a pachymeningitis. 
Marked psychoses occur from the abuse of alcohol. Many of 
these take the form of paranoia. Some of the striking symptoms 
of alcoholic psychoses are delirium with hallucinations of sight 
and hearing, retrograde amnesia, etc. The peripheral nervous 
system is also affected with the development of neuritis, with pain 
in the limbs, tremors and paralysis. The toxic effects on the 
metabolism may predispose to gout, arteriosclerosis and con- 
tracted kidney. 

Methyl Alcohol, otherwise known as wood alcohol, is of no 
importance in therapeutics, but it has become very interesting of 
late on account of numerous cases of poisonings arising from its 
use. The source has been from the adulteration of ethyl alcohol 
or from patent medicine containing this product. It is much 
more poisonous than ethyl alcohol, and this is probably because 
it is oxidized to formic acid and formic aldehyde, which are 
themselves poisonous. Besides the symptoms of narcosis, this 
drug produces very marked local irritant action and also convul- 
sions. It not infrequently causes optic neuritis with atrophy and 
blindness. 

SUMMARY OF THE GROUP ACTION.— The central nervous 
system is depressed in the following order, brain, cord and medulla. 
The heart is never directly stimulated but depressed with large doses, 
and especially by members containing halogens, as chloral and 
chloroform. Local irritation is well marked and may give rise to 
reflex influences on respiration and circulation. 

THERAPEUTIC APPLICATION.— The main use of the mem- 
bers of this group is derived from their depressant action on the 
brain and cord. They may be used according to the dose, either 
to depress mildly the cerebrum and thus to produce sleep, or to 



GROUP OF ETHER AND CHLORAL. 27 

paralyze completely the cerebrum and cord and thus induce 
complete loss of consciousness and of the reflexes, also to cause 
insensibility to pain. 

Anesthesia, or the complete loss of consciousness produced to 
enable the performance of painless surgical operations, is more 
appropriately brought about by the gaseous or very volatile 
liquids of this group. These are easily absorbed and easily 
excreted so that the intensity of action can be conveniently 
regulated. The so-called anaesthetics, include ether, chloroform, 
nitrous oxide, ethyl bromide, pental, etc. 

To induce simple sleep, the solids, or the less easily volatilized 
liquids are best adapted because of their slower absorption and 
excretion. Their action is more prolonged, but becomes less 
rapidly intense. The chief members of this division, sometimes 
called that of hypnotics or soporifics, are chloral, sulphonal, 
tetronal, trional, veronal, hedonal, urethane, paraldehyde and alcohol. 

Sleep is, like the waking state, an active condition of the living 
organism. Its purpose is to rest the tired cells in order that they 
may not become the prey of auto-intoxication. Different condi- 
tions are important in the occurrence of sleep. These are limita- 
tion of voluntary movements, an abstract state of the mind or a 
monotonous stimulus, also a lowering of the general reflexes. 
Such drugs as the bromides, to be considered in a subsequent 
group, help in the production of sleep by decreasing the ingoing 
stimuli and limiting voluntary motion. The drugs of the chloral 
group, on the contrary, act by decreasing the functional activity 
of the brain. It can easily be seen that the sleep produced by 
these drugs is different from normal sleep and is akin to a partial 
paralysis of the brain. It is for this reason that in spite of the 
claim of manufacturers, all are prone to produce unpleasant 
symptoms on awaking just as after having taken an excess of 
alcohol, and instead of feeling refreshed patients frequently feel 
tired, dizzy, nauseated, etc. 

The most powerful, rapidly acting and reliable is chloral. It 
has been accused of being the most depressant drug of the group 
towards the circulation and respiration, yet when used in small or 



28 CONSTITUTIONAL ORGANIC DRUGS. 

moderate doses it does not seriously affect these functions unless 
they are already depressed by disease. It is quite irritant to the 
mucous membrane of the stomach and therefore should be ad- 
ministered in a watery solution well diluted with water or pre- 
ferably with milk. The best method of prescribing it is in the 
form of a syrup containing about 0.5 G. or 7 grains to the tea- 
spoonful. One teaspoonful may be given % hour before bed- 
time and repeated in 2 hours if sleep has not occurred. On ac- 
count of its great irritant action it should never be given in the 
form of tablets, powders, or capsules. This drug or any other of 
this group should not be used to produce sleep unless sleeplessness 
has become a dangerous symptom which can not be controlled 
by the simple sedatives of the bromide group or by hydro- thera- 
peutics, general hygienic measures, etc. The most valuable indi- 
cations for the use of chloral are in maniacal or alcoholic delirium, 
or in convulsions of all sorts, as in strychnine poisoning and teta- 
nus. Chloral has also been found valuable in lessening the pains of 
labor and in affording sleep during the middle of prolonged par- 
turition. Great caution should be exercised in the use of chloral 
or, in fact, any other narcotic of this group when there is present 
organic weakness of the heart. 

It was formerly asserted that sulphonal, veronal, but especially 
paraldehyde and urethane were perfectly safe drugs, but all have 
against them a record of deaths following their administration. 

Sulphonal, tetronal, trional, veronal, neuronal, isopral, 
etc., have all been prescribed chiefly in powder or tablet form on 
account of their rather difficult solubility in water: their ingestion 
should be followed by a hot drink, particularly an alcoholic one, 
because this aids their absorption. They also should be given 1 
or 2 hours before sleep is desired as their action is much slower 
than that of chloral. They have also a well-marked irritant 
effect upon the stomach, like chloral, and may produce nausea and 
vomiting. 

Ethyl carbamate or urethane being very soluble in water, is 
best given in the form of a watery solution or syrup containing 
1 G. or 15 grains to the teaspoonful. It is one of the safest mem- 



GROUP OF ETHER AND CHLORAL. 20. 

bers of this group, but unfortunately is often not powerful enough 
to produce sleep except in very large doses. 

Paraldehyde having such a bad taste and odor is best given 
in the form of an elixir containing 2 c.c. or 30 minims to the table- 
spoonful. It is a fairly safe hypnotic if too large doses are not 
used, but like ethyl carbamate it frequently fails to produce sleep. 

Alcohol is used in medicine both internally and externally. 
Its external use is by virtue of its irritant and bactericidal action. 
As an irritant it is employed to stimulate the circulation of the 
skin either over the whole body or local parts. As an antiseptic 
it is employed very much more nowadays than in the past, and 
in fact many surgeons use it exclusively for the disinfection of the 
abdomen before laparotomy and also for the sterilization of some 
surgical instrument. 

Internally it is used to some extent, but less than in the past, as 
a narcotic in cases of sleeplessness. For this purpose the common 
alcoholic beverages, as ale, beer, porter, are generally employed. 
It is used as a gastric stimulant in anorexia in cases of nervous 
fatigue and atony of the stomach in the form of some alcoholic 
beverages before meals. It is also employed, but less than in the 
past, in febrile diseases, as pneumonia and typhoid fever. The 
general impression among physicians is that its good effect in 
these and similar diseases is derived from a stimulant effect upon 
the heart. This impression is erroneous and the good probably 
comes from its virtue as a food. 

General anaesthesia is used chiefly for the performance of 
surgical operations, for painful examinations, or in labor. 

The apparatuses used for administering anaesthetics differ to a 
considerable extent according to the choice, but there are certain 
general principles which govern the use of all volatile anaesthetics 
and these are based upon the laws of partial pressure of gases. 
As it has been found experimentally that certain definite propor- 
tions of the various anaesthetics are required to produce anaes- 
thesia, methods have been devised of making definite mixtures of 
the anaesthetics with air or oxygen. All forms of inhalers, from 
the very simplest to the most complicated, are in use. 



30 CONSTITUTIONAL ORGANIC DRUGS. 

Preliminary to anaesthesia, a patient should be very carefully 
examined and if she shows evidence of marked myocarditis it 
is dangerous to proceed, especially with chloroform, which may 
produce degeneration of the heart's muscle. If marked arterio- 
sclerosis is present both ether and nitrous oxide are contra- 
indicated because they both may cause a temporary increase of 
blood pressure. Bronchitis, colds or any irritation of the lungs 
make the patient a little more liable to anaesthetic pneumonia. 
Ether is much more dangerous in this respect than chloroform. 
Advanced Bright's disease or diabetes contraindicate both ether 
and chloroform. Marked anemia is also an undesirable condi- 
tion in which to give any anaesthetic. 

The problem of practical anaesthesia is by no means a simple 
one and in England and recently in America the best surgeons 
realizing this fact employ only trained anaesthetists. The gen- 
eral principles are as follows : the stomach and intestines should 
be as nearly empty as possible. The intestines may be cleaned 
by a high enema the night before operation and the stomach 
should have only received easily digestible food the night before 
the operation and a small quantity of light liquid nourishment 
a few hours before. Great care should be exercised to see that 
the patient has no false teeth or other foreign objects in his 
mouth and also that his clothing is loose all about the body so 
as not to interfere with his respiration, also that he is suitably 
covered with blankets or warm water bottles in order that he 
will not suffer lowered resistance by cold. In the case of ether or 
chloroform, when given by the open method not previously mixed 
in a tank with oxygen, they should be administered on a light 
permeable inhaler held some distance from the face while the 
eyes are kept closed to prevent their irritation. Great care 
should be taken that the cone is not too near the face when the 
patient takes a deep respiration. Also when anaesthesia is very 
advanced that the patient is not choked by swallowing his tongue 
or by inhaling vomitus or mucus. The tongue can be pressed 
forward by pushing on the angles of the jaw or by pulling out this 
organ with a towel or forceps. Mucus or vomitus may be re- 



GROUP OF ETHER AND CHLORAL. 3 1 

moved by turning the head to one side and sponging out the 
mouth with gauze. If during anaesthesia there is sudden arrest 
of respiration this may be remedied by removing the anaesthetic 
and giving respiratory stimulant and artificial respiration. 
Should the heart fail, due to inhibitory stimulation, the treatment 
consists of inverting the patient and giving massage of the heart 
and artificial respiration. Atropine may be found useful, as it 
paralyzes the inhibitory mechanism, and is best administered by 
direct injection into a vein or into the heart itself. 

During the past few years many arguments have been adduced 
both for and against the use of some narcotic before general ances- 
thesia. The purpose is to ease the stage of going under the 
anaesthetic and also to permit a smaller amount of the same to 
be used. For a long time it was recommended to give atropine 
in order to prevent the disagreeable excessive bronchial mucus. 
In recent days, the hypnotics of the chloral group, as chloral 
itself, hedonal and veronal, have been urged as adjuvants to the 
anaesthesia. The best method of preparation is undoubtedly 
the administration of morphine % grain and scopolamine riro 
of a grain 1 to 2 hours before anaesthesia. This procedure in 
itself has been followed by complete anaesthesia and it undoubt- 
edly decreases enormously the amount of the volatile anaesthetic 
which has to be employed. It also decreases the amount of 
bronchial mucus and the chances of inhibitory arrest of the heart 
by means of scopolamine which acts in many respects like atro- 
pine. 

For general anaesthesia the drugs most commonly employed 
at the present time are ether and chloroform. The anaesthesia 
with ether or chloroform is usually preceded, if not by morphine 
and scopolamine, by the use of some much more rapidly acting 
volatile anaesthetic, as nitrous oxide, ethyl chloride, etc. Chloro- 
form is by no means unpleasant and can be used from the begin- 
ning, but with ether it is positively barbarous to begin anaesthesia 
with this substance as it is so unpleasant and takes so long to 
produce unconsciousness unless pushed dangerously fast. Ether 
anaesthesia may be begun with chloroform. 



32 CONSTITUTIONAL ORGANIC DRUGS. 

Other methods, besides inhalation of volatile anaesthetics, 
have been devised and used practically in recent days. They 
comprise rectal, intravenous, intratracheal and intramuscular 
anaesthesia. 

Rectal anaesthesia with the use of ether or chloroform was 
first introduced over twenty years ago, but was soon abandoned 
at that time because the introduction of ether in substance, or 
of too concentrated ether vapors, caused alarming inflammation 
of the intestines. Within the last few years', Cunningham re- 
vived this method, using ether vapors laden with watery vapors, 
well diluted and heated at the temperature of the body. By this 
method and the use of a very simple apparatus, he and others 
were able to carry out rectal ether anaesthesia with only rare 
evidence of intestinal irritation. The advantages claimed by 
Cunningham were, that rectal anaesthesia permitted more easily 
of operative procedures about the face, was pleasanter to take 
and seldom produced nausea and vomiting. In using this method 
a careful examination of the intestines by abdominal palpation, 
sigmoidoscopic and fecal examination should be made, as one 
death was reported, due to rupture of an amebic ulcer. 

Intravenous anaesthesia with ether and chloroform was intro- 
duced by Burkart a few years ago and used by him both in ani- 
mals and on human beings. He conducted the anaesthesia by 
running into a vein of the arm at a very slow rate, a solution of 
y 2 per cent, chloroform or 5 per cent, ether. The duration of the 
infusion lasted about one hour. This author obtained no ill 
effects, such as headaches, nausea, vomiting. In a few patients, 
there was evidence of slight renal irritation. The object of this 
method was to facilitate operations about the head and also to 
overcome the disagreeableness and post-narcotic symptoms pres- 
ent after inhalation anaesthesia. 

Since Meltzer and Auer demonstrated the possibility of in- 
tratracheal anaesthesia upon animals, several anaesthetists and 
surgeons have worked to apply this method upon human beings. 
While in animals tracheotomy is performed, in human beings a 
catheter is introduced into the larynx and trachea, just as the 
intubation apparatus for diphtheria. The ether vapors diluted 



GROUP OF ETHER AND CHLORAL. 33 

with air or oxygen, likewise nitrous oxide oxygen mixtures, are 
pumped rhythmically into the lungs. Cotton, Boothby, and 
Ehrenfried have perfected an apparatus simplifying this method 
and report very favorably on the result obtained. The chief 
claim for the introduction of this method is on the ground that it 
is much safer than the inhalation method and that it can be more 
easily controlled, since if too much anaesthetic has been taken, in 
a moment pure oxygen can be introduced into the lungs rhyth- 
mically and thus revive the subject. 

Recently, in Paris, intramuscular ether anaesthesia has been 
placed in practical operation. The amount of ether required 
was about the same number of c.c.'s as kilo weight of subject. 

Ether and Chloroform are the two commonly employed to 
bring about complete ancesthesia during major surgical operations. 
It requires a much longer time to produce unconsciousness with 
ether than with chloroform. Ether causes more marked vomit- 
ing and irritation of the respiratory tract because much more of 
this drug has to be used to produce the same narcosis as with 
chloroform. On the other hand, ether is less depressant to the 
circulation and less liable to produce fatty degeneration of paren- 
chymatous organs than chloroform. The former is better 
adapted when there is a disease attended with decreased strength 
of the circulation or parenchymatous degeneration of certain 
organs. 

Ether and chloroform have been used in the form of waters, 
spirits, emulsions, etc., by virtue of their local anaesthetic action 
in painful functional affections of the stomach. They are not well 
adapted for organic diseases of this organ because of the irritation 
which they produce. 

Ether and chloroform are used in the form of liniments as 
counterirritants on the skin over diseased parts, such as rheumatic 
joints. Here their beneficial action is probably due to reflex 
changes in the circulation and metabolism of the affected part. 

Ethyl bromide cannot be used as an anaesthetic in major 
surgical operations, because complete surgical anaesthesia with 
muscular relaxation cannot be obtained without death of the pa- 
3 



34 CONSTITUTIONAL ORGANIC DRUGS. 

tient, since the centre of respiration is paralyzed at the same 
time that the reflexes are abolished. It can only be used when 
short and incomplete anaesthesia can be of service, such as for 
opening abscesses or in small gynecological operations, or in par- 
turition. 

It is usually administered by saturating a cone with about 30 
c.c. or 1 fluid oz. and kept over the face until anaesthesia results. 

Ethyl chloride which has a very low boiling point (12 C.) 
has been used for many years to produce local anaesthesia by 
freezing. It is kept in sealed tubes and sprayed over the part to 
be operated until it becomes anaesthetic from the cold. More 
recently, however, it has been reintroduced as a general anaes- 
thetic by inhalation. It has some very decided advantages. 
Firstly, it is very rapid in its action, producing loss of conscious- 
ness within two to three minutes. It has not proved dangerous 
when employed in small amounts. Its effect is very fleeting 
because of its low boiling point and, therefore, is not as practical 
as others for prolonged anaesthesia. Its chief indication is for 
short anaesthesia or for beginning anaesthesia to be continued by 
other anaesthetics. 

Nitrous oxide has not received much attention as an anaes- 
thetic in major surgical operations until the last few years. 
However, since its discovery by Wells, it has been enormously 
employed for short anaesthesia to enable the performance of 
minor surgical operations, such as pulling of teeth, opening ab- 
scesses, dilatation of the anal sphincter, and to begin anaesthesia 
which is to be continued by ether or chloroform or other more 
powerful anaesthetics. For short anaesthesias, it has been em- 
ployed in the absence of air so that the anaesthesia came very 
quickly but lasted but a very short time. 

Many years ago, Paul Bert demonstrated the feasibility of 
giving nitrous oxide for major surgical operations provided that 
it was administered under pressure and with 20 per cent, oxygen. 
Until recently this method was not found very practical, 
because of the cumbersome apparatus needed. Lately, several 
American surgeons and anaesthetists have worked to simplify 



GROUP OF ETHER AND CHLORAL. 35 

methods and apparatuses for the use of nitrous oxide in major 
surgical operations. One of the most successful and enthu- 
siastic has been Crile of Cleveland, who has used it in hundreds 
of cases for all sorts of major surgical operations, lasting, in some 
cases, over periods of hours, with most excellent results. The 
claim in favor of nitrous oxide as compared with ordinary ether 
anaesthesia is that it is less dangerous, much pleasanter to the 
patient, much more rapid in its action, and producing less shock. 
In a comparative series of over five hundred cases, Crile found 
that vomiting followed nitrous oxide in only 17 per cent, of cases, 
while it followed ether in 42 per cent. 

MATERIA MEDICA. 

(a) Anaesthetics. 

^ther (U.S.P.,* B.P.)*, light, colorless, inflammable liquid, consisting of 
96% of absolute ether, with a peculiar penetrating odor and burning taste, 
boiling at 38 C, miscible with alcohol, chloroform and fats, soluble in 10 
parts of H 2 0. Its vapors are heavier than air and are highly inflammable. 
Dose: — 0.3-2.0 c.c. Br. (8-15 itjj.) Average (U.S.P.) 1.0 c.c. 

Spiritus Athens Compositus (U.S.P., B.P.) (Hoffman's Anodyne) 
consists of about one-third ether with the balance of alcohol and ethereal 
oils. Dose: — 1.0-4.0 c.c. Br. (>£-i fl. 5.) Average (U.S.P.) 4.0 c.c. 

Chloroforum (U.S.P., B.P.) heavy, colorless, non-inflammable liquid with 
a pleasant odor and burning sweet taste, consisting of about 99% absolute 
chloroform, boiling at 62 C, miscible with ether, alcohol and fats, soluble 
in 200 parts of H 2 0. Dose: — 0.1-1.0 c.c. Average (U.S.P.) 0.3 c.c. 

Emulsum Chloroformi (U.S.P.) contains 4 per cent, chloroform. Dose : 
— 5.0-15.0 c.c. Average (U.S.P.) 8.0 c.c. 

Spiritus Chloroformi (U.S.P., B.P.) contains 6 per cent, chloroform. 
Dose: — 2.0-5.0 c.c. Br. (}4~i 5-) Average (U.S.P.) 2.0 c.c. 

Aqua Chloroformi (U.S.P., B.P.) contains }£ per cent, chloroform. 
Dose: — 5.0-15.0 c.c. Br. (1-3 fl. 5-) Average (U.S.P.) 16.0 c.c. 

Linimentum Chloroformi (U.S.P., B.P.) contains 30 per cent, chloro- 
form. 

^thylis Bromidum, light, colorless, inflammable liquid, soluble in or- 
ganic solvents, easily decomposed by light and air, boiling at 3 8° C. Dose : 
— 10-20 c.c. by inhalation. 

Pentalum, light, colorless, inflammable liquid, boiling at 38 C. 

^Dthylis Chloridum (U.S.P.), light, colorless liquid, boiling at 12 C. 
Kept in tubes under pressure. Used as a spray to produce local anaesthesia. 

Nitrous Oxide, colorless gas, without odor, but with a sweet taste, 
soluble in water. It is kept in tanks under pressure. 

*(U.S.P.) means that a drug is described in the United States Pharmacopoeia. 
*(B.P.) means that a drug is described in the British Pharmacopoeia. 



36 CONSTITUTIONAL ORGANIC DRUGS. 

(b) Hypnotics. 

(1) Chloral Division. 

Chloralum Hydratum (U.S.P.) or Chloral Hydras (B.P.), sometimes 
called chloral is hydrated trichloraldehyde, composed of colorless crystals, 
melting at 58 C, with a sweet pleasant odor and a burning taste, soluble in 
water, alcohol and ether. It is liquefied when rubbed with equal parts of 
camphor, thymol, menthol or phenol. Dose: — 0.3-1.0 up to 5.0 G. in 
24 hours. Br. (5-30 grains.) Average (U.S.P.) 1.0 G. 

Butyl Chloral Hydras (B.P.) resembles chloral closely. Dose: — 
0.3-1.0. Chloralformamide, chloralose, chloretone, hypnal, dormiol, ural 
and somnal are chloral derivatives resembling it in its action and uses. 
Dose: — 0.3-1.0 G. Br. (5-15 grains.) 

(2) Sulphonal Division. 

Sulphonmethanum (U.S.P.) or Sulphonal (B.P.) and Sulphonethylme- 
thanum (U.S.P.) or Trional and Tetronal, three sulphon derivatives, are 
white crystalline bodies only soluble in a few hundred parts of water, but 
readily soluble in hot alcohol. Dose: — 0.3-1.0 G. Br. (15-30 grains.) 
Average (U.S.P.) 1.0 G. 

(3) Miscellaneous Division. 

Paraldehydum (U.S.P., B.P.), colorless liquid with a disagreeable odor 
and burning taste, soluble in alcohol and ether, soluble in 8 parts of water. 
Dose: — 1.0-5.0 G. Br. (15-30 ttjO- Average (U.S.P.) 2.0 c.c. 

Amylene Hydrate, colorless liquid, soluble in water and alcohol. Dose : 
— 1.0-2.0 G. 

JEthylis Carbamas (U.S.P.) or urethane, white crystals, soluble in water 
and alcohol. Dose: — 1.0-2.0 G. Average (U.S.P.) 1.0 G. 

Hedonal and Veronal are urethane derivatives, difficultly soluble in 
water. Dose: — 0.3-1.0 G. 

Alcohol (U.S.P.), colorless, inflammable liquid, miscible in water, ether, 
and chloroform, and contains 92.3 per cent, absolute alcohol by weight. It 
has a pleasant odor and burning taste. 

Spiritus Rectificatus (B.P.) contains 90 parts pure alcohol by volume. 

Alcohol Dilutum (U.S.P.), 41.5 per cent, alcohol, balance H 2 0. 

Spiritus Frumenti (U.S.P.), whiskey. 

Spiritus Vini Gallici (U.S.P., B.P.), brandy. 



GROUP OF AMYL NITRITE. 

Amyl nitrite and other nitrites form a group of drugs whose 
pharmacological action is probably due to the nitrous acid 
radicle. 

AMYL NITRITE has a marked effect upon the circulation. // 
lowers greatly the blood pressure by paralyzing the smooth muscles 
in the walls of the internal blood vessels. At first, it only causes 
a dilatation of the superficial vessels, especially those of the face 
and upper part of the body, so that the skin becomes hot, red- 
dened, suffused, and covered with perspiration; it also dilates 



GROUP OF AMYL NITRITE. 37 

the vessels of the head, including those of the meninges, produc- 
ing a throbbing sensation in the head and neck. It even raises 
the blood pressure in this stage and only decreases it later when 
the internal vessels are paralyzed. 

To compensate for the diminished blood pressure, the heart 
increases in rate, although not in force; the pulse is full and bound- 
ing, because the relaxed condition of the vessel walls greatly 
favors the transmission of the impulse. With sufficient doses, 
the heart muscle becomes depressed, and both the rate and force of 
this organ are decreased, until complete arrest occurs. 

The body temperature is lowered on account of the increased 
loss of heat through the dilated cutaneous blood vessels. 

When directly applied, amyl nitrite paralyzes both striped 
and unstriped muscles, but mainly the unstriped and especially 
those of the blood vessels. 

It induces changes upon the nervous system, that may be 
seen even after medicinal doses, in the forms of giddiness, vertigo, 
disturbances of vision and hearing, and even unconsciousness. 
In large toxic doses, it produces the same effects upon the central 
nervous system as the members of the ether and chloroform 
group, i. e., depression of the cerebrum, spinal cord, and medulla. 

Respiration is at first slightly increased in force and rhythm, 
but with larger doses it is depressed and finally arrested. The 
primary increase in respiration is a reflex phenomenon, depen- 
dent upon the local irritant action of the drug. Other evidences 
of local irritation seen after inhaling amyl nitrite, are coughing, 
watering of the eyes, and occasionally nausea and diarrhoea. 

The blood is profoundly affected and after large doses, methcemo- 
globincemia appears, giving to this tissue a chocolate brown color, 
and to the skin, a cyanotic appearance. Since the oxygen in 
methaemoglobin is not easily available for vital oxidation, death 
may take place from asphyxia. 

The urinary flow is not usually increased as was formerly sup- 
posed, and on account of the fall of blood pressure, it may even be 
decreased or arrested. Part of the nitrite radicle administered 
becomes oxidized in the body to a nitrate; another portion is possibly 



38 CONSTITUTIONAL ORGANIC DRUGS. 

reduced to ammonia; still another portion remains unchanged, 
and is found in the urine in the form of alkaline nitrites. 

ETHYL NITRITE and other organic nitrites, resemble closely 
amyl nitrite in their action, but as a rule are weaker. 

SODIUM NITRITE, and other inorganic nitrites, possess the 
same general action as amyl nitrite, but being solids, they are less 
readily absorbed, therefore, their action is slower in appearing, but 
more prolonged. 

NITROGLYCERINE, or trinitrate of glycerine, which is slowly 
broken up in the body with the formation of nitrites, nitrates and 
glycerine, has essentially the same action as the nitrites. Because 
it is rapidly absorbed, the effect soon appears, and as it is slowly 
decomposed, the same is prolonged. It is much more apt to 
produce severe headaches than the other members of this group. 
These, and the convulsions observed in the lower animals, may 
be due to the action of the nitroglycerine group before decompo- 
sition. 

Cases of poisoning by nitroglycerine from inhalation of dyna- 
mite smoke, or from handling of this product, show symptoms 
very similar to those produced by amyl nitrite, as reddening of 
the upper extremities, knocking in the head, dizziness, sometimes 
loss of consciousness, headaches and convulsions. The two lat- 
ter symptoms are seen more markedly with nitroglycerine. In 
isolated heart experiments, this drug is found to relax the heart 
contracted by digitalin. 

SUMMARY OF THE GROUP ACTION.— At first, dilatation of 
the superficial blood vessels with blushing of the face and neck, later, 
dilatation of the internal vessels, with fall of blood pressure. With 
larger quantities, paralysis of the central nervous system in the 
same order as from ether, therefore narcotic effect, also, depres- 
sion of the heart muscle and methcemoglobincemia. 

THERAPEUTIC APPLICATION.— Amyl nitrite was first in- 
troduced in medicine, by Brunton, for the treatment of angina pec- 
toris, on the theory that the spasmodically contracted vessels in 
the heart are relaxed by the depressant effect of this drug on the 
vessel walls. It is certain that the agony of an attack of angina 



GROUP OF AMYL NITRITE. 39 

pectoris is frequently shortened by the inhalation of a few drops 
of amyl nitrite. Nitroglycerine is also employed for the same 
purpose. The inorganic nitrites are not so applicable during 
anginal attacks, because they act too slowly. 

The nitrites are sometimes used to lower the blood pressure, 
and thus relieve the work of the heart in cases of arteriosclerosis, 
when this organ is laboring against too high blood pressure. 
They are employed in epilepsy and migraine, on the theory that 
these conditions may be due to spasmodically contracted blood 
vessels in the brain. On account of their depressant action on 
smooth muscle fibres, they are given in asthmatic attacks, to re- 
He ve the supposed spasm of the smaller bronchi. 

Ethyl nitrite in the form of sweet spirits of nitre, has been 
used for many years to increase the flow of urine and sweat. 
It has but little action on the urine, but under favorable conditions 
it may well produce sweating by dilating the cutaneous blood 
vessels. 

MATERIA MEDICA. 

Amylis Nitris (U.S.P., B.P.) (Co Hn N0 2 ) yellow, volatile, liquid with a 
strong odor of banana and a burning taste, soluble in alcohol and ether. 
It contains 80 per cent, of absolute amyl nitrite, the balance being composed 
of by-products. It is usually dispensed in glass pearls which can be broken 
in a handkerchief and inhaled during attacks. Dose: — 0.1-0.3 c - c - Br. 
(1-5 ttjO- Average (U.S.P.) 0.2 c.c. 

Spiritus Athens Nitrosi (U.S.P., B.P.), clear, mobile, slightly yellow 
liquid, with a sharp burning taste and an ethereal odor, which contains 4% 
of ethyl nitrite, and the rest alcohol. Dose : — 1.0-5.0 c.c. Br. (20-90 ng). 
Average (U.S.P.) 2.0 c.c. 

Spiritus Glycerylis Nitratis (U.S.P.) or Liquor Trinitri (B.P.), colorless 
liquid, with smell and taste of alcohol, consisting of 1 part nitroglycerine to 
99 parts alcohol. Dose: — 0.06-0.1 c.c. Br. (j^-2 tt£). Average (U.S.P.) 
0.05 c.c. 

Tabellae Trinitriti (B.P.), contains 0.0006 G. (rib grain) nitroglycerine. 
Dose : — 1-2 tablets. „ 

Sodii Nitris (U.S.P., B.P.) (NaN0 2 ) white crystalline body, soluble in 
water. It is deliquescent and gradually changed to sodium nitrate when 
exposed to the air. Dose : — 0.1-0.3 G. Br. (1-2 grains). Average (U.S.P.) 
O.065 Cr. 



40 CONSTITUTIONAL ORGANIC DRUGS. 

GROUP OF MORPHINE. 

Among the Ancients, the poppy was the emblem of sleep, and 
for centuries opium in some form has been used in different coun- 
tries as an intoxicant and as a sleep producer. Just as for alcohol, 
and in fact for all intoxicants, it is claimed by those who are 
habituated to its use, that they derive marked pleasure from it. 

This group is composed chiefly of alkaloids extracted from 
the opium poppy, morphine, being the most prominent mem- 
ber, and, the one to which opium chiefly owes its activity. 

MORPHINE, by a depressant effect on the cerebrum, relieves 
pain and produces sleep, and when administered to an animal, loss of 
the sensation of pain is the first action observed. This is followed 
by drowsiness which soon passes into sleep, from which the sub- 
ject can at first be aroused. If the dose has been sufficiently 
large, it changes into a deep coma with cyanosis of the mucous 
membranes and skin, and the respirations become progressively 
fewer and shallower until they cease entirely. Even with small 
doses, as might be used in practice, morphine greatly lowers the 
respiratory capacity, and with sufficiently large ones, it produces 
death by paralysis of the centre of respiration in the medulla. 

Unlike the members of the chloral group, it increases the re- 
flex irritability of the cord in the lower animals, although in man, 
depression of the cerebrum is more marked than stimulation of 
the cord, so that, as a rule, in the latter only a sedative action 
follows the use of morphine. In some lower animals such as 
frogs, and occasionally in human beings with an idiosyncrasy 
towards morphine, it produces excitement and actual convulsions 
by stimulation of the cord. After awaking from morphine sleep, 
there may be noticed in man, more or less nausea or vomiting and 
depression, and occasionally headache and excitement. In dogs, 
morphine practically always produces vomiting within ten to 
fifteen minutes after subcutaneous administration. This effect is 
probably due to stimulation of the vomiting centre just as after 
apomorphine. The muscles and peripheral nerves are not 
affected by morphine except when applied in overwhelming 
amounts, and this drug is in no sense a local anaesthetic. 



GROUP OF MORPHINE. 4 1 

Morphine, in human beings, does not depress the heart nor the 
vasomotor centre governing the internal blood vessels except in 
very excessive doses. Thus, the blood pressure and pulse may re- 
main normal when there is already profound narcosis and depression 
of respiration; and in fact, death may occur with the blood pres- 
sure but little changed. The cutaneous blood vessels are, how- 
ever, markedly dilated and this causes redness of the skin, sweat- 
ing and itching. The congestion of the skin by the chronic use 
of morphine may even produce eczemas which are frequently 
observed in the habitues of this drug. 

Probably through its action on the central nervous system, 
morphine decreases all secretions except sweat. The bronchial 
and intestinal secretions are the most affected. The peristalsis 
of the gastro-intestinal tract is also diminished so that constipa- 
tion is often produced; in human beings having an idiosyn- 
crasy toward this drug diarrhoea may occur by stimulation of the 
cord. Recently it has been found by Magnus that morphine 
delays the emptying of the stomach, from six to seven hours 
longer than usual, because of spasm of the pylorus. The pupils 
are contracted by central stimulation until just before death from 
asphyxia when they become widely dilated. 

In subjects upon which morphine has a depressant action, the 
metabolism is reduced, as is also the heat production, and on 
account of the diminution in the respiration, there is imperfect 
oxidation and in consequence lactic acid and sugar may be found 
in the urine. Otherwise this secretion remains unaffected, al- 
though retention may occur in the bladder, due to the loss of 
normal reflex of urination. 

It is chiefly excreted unchanged by the mucous membrane of the 
stomach and intestines and so rapidly, that it may be detected in 
the stomach even in a few minutes after subcutaneous adminis- 
tration, and about forty per cent, of the quantity given is thrown 
out into this organ within an hour. The rest is excreted by the 
bowels, as under normal conditions but a small part of the mor- 
phine ingested is oxidized to oxidimorphine, which appears in 
traces in the urine. When, however, slowly increasing doses are 



42 CONSTITUTIONAL ORGANIC DRUGS. 

given to a subject, the latter acquires the power of oxidizing pro- 
gressively larger quantities of this drug, and whereas normally 
over seventy per cent, is found in the feces, in habitues, only 
traces may be recovered. Experiments have shown that the 
brain of animals habituated to morphine have a much greater 
capacity of oxidizing this drug than a normal brain. This would 
explain the immunity. 

When morphine is taken for a certain length of time, a growing 
desire to continue its ingestion arises. After the habit is ac- 
quired, the sudden withdrawal of the accustomed dose produces 
very disagreeable symptoms, which consist of a craving for the 
drug, often, of diarrhoeas, great depression, and even collapse. 

Morphinism, is usually attended by the following symptoms; 
depravity of the mind, general debility, loss of weight and appe- 
tite, loss of sexual powers, sleeplessness, eczemas, contracted 
pupils, diarrhoea alternating with constipation and finally, death 
from malnutrition. 

In acute morphine poisoning, the rational treatment con- 
sists of emptying the gastro-intestinal tract where morphine is 
excreted, by repeated stomach washings and by the administra- 
tion of purgatives. The respiration should be stimulated by 
respiratory stimulants, and, if necessary, artificial respiration 
should be performed. The treatment of chronic morphine 
poisoning should consist of a gradual withdrawal of the drug, 
of improving the nutrition by suitable measures, and of treating 
symptoms as they arise. 

CODEIN is an alkaloid of opium which has similar, but less 
intense action, than morphine. It usually does not constipate, 
nor diminish the bronchial secretions, neither does it produce a 
habit, as does morphine. It increases reflex irritability more, and 
decreases the sensation of pain and consciousness less than the latter 
drug; although in man, in ordinary doses, no increase in the re- 
flexes occurs. The sleep obtained by medicinal doses of codein 
is much less profound than that of morphine and the patient 
usually wakes up easily. When much pain is present, codein is 
as a rule absolutely inadequate in affording relief. 



GROUP OF MORPHINE. 43 

In order to overcome some of the objectionable features of 
morphine, various artificial derivatives of this substance were 
made. The most important are Dionin and Peronin, which 
have an action closely resembling that of codein. Heroin de- 
presses the respiratory centre very profoundly, even more so than 
morphine itself, yet it does not decrease pain nearly as much as 
the latter. More recently, there was introduced a crystalline 
mixture of all the alkaloids of opium called pantopon with the 
claim that it was much more efficient than crude opium or any 
single one of its alkaloids. This, however, has not been absolutely 
borne out. 

CANNABINOL, the active principle of cannabis indica, has nar- 
cotic properties resembling those of the alkaloids of opium, and 
preparations of the crude drug called Hashish or Bhang, have 
been used for centuries in India in the same way that opium has 
been used by the Turks. The East Indians claim, that under its 
influence they are thrown into a sleep accompanied by the most 
delicious erotic dreams, but the Caucasians experience only as 
a rule a general feeling of comfort and well-being and rarely 
delusions. Occasionally, the dreams are of a disagreeable charac- 
ter and the patient awakes with great depression, nausea and 
vomiting as may occur after taking morphine. The hallu- 
cinations sometimes present, consist of creeping sensations in the 
hands and feet, also a feeling as if the individual were swimming 
or flying. 

Death has seldom occurred in man after taking even very 
large doses of cannabis indica. The most marked symptoms of 
poisoning which have been observed, consisted of great quickening 
of the pulse, weakness, general loss of strength, convulsive con- 
tractions of the extremities and trismus, and lastly, sleep from 
which the patient completely recovered. 

Animals are not very susceptible to cannabinol, for rabbits 
may take five grams by the stomach without any symptoms, 
although dogs are more susceptible, yet never die from its effect. 
The symptoms which they show, consist of restlessness followed 
by somnolence. With large doses, the animal lies unconscious 



44 CONSTITUTIONAL ORGANIC DRUGS. 

on the floor, taking deep stertorous respirations and occasionally 
having muscular twitchings. Vomiting frequently occurs in both 
dogs and cats. 

The reflex irritability is first increased then diminished in 
frogs ; the pulse is as a rule accelerated in man, due to the exalted 
psychical condition, but in animals it is usually slowed by stimula- 
tion of the vagus and by action on the heart itself. This organ 
stops even before respiration after subcutaneous administration 
in animals. 

Dogs become easily accustomed to cannabinol, so that perfectly 
enormous doses may be taken without symptoms. The chronic 
use of cannabis indica preparations in the East is occasionally 
accompanied by mental derangements, and the profound distur- 
bance of nutrition seen after opium is also observed in the habi- 
tues of Hashish, although many East Indians take it in small 
quantities during their entire life without any symptoms. 

Cannabinol, like morphine, greatly decreases the sensation 
of pain and may entirely suppress it with large doses. It has also 
less effect upon the sense of touch. 

PELLOTIN is an alkaloid obtained from a Mexican cactus, 
which is made into a beverage and drunk by the natives. It pro- 
duces pleasant sensations, somewhat on the order of those which 
the East Indian experiences from Hashish. It has well marked 
narcotic action, but does not decrease the sensation of pain as 
does morphine, resembling more in this respect the narcotics of 
the chloral group. It has a depressant action on the respiratory 
centre and also upon the heart, the latter being slowed in beat 
and decreased in force. The other alkaloids accompanying 
pellotin in this cactus, have more or less marked narcotic prop- 
erties, but one of them, mescalin, produces great excitement 
and exaltation, such as the perception of brilliant colors and so 
forth, and is probably the principle to which Pellote or Mescale 
the Mexican beverage owes its exciting properties. 

LACTUCARIUM, or an extract of lettuce juice, has been used 
considerably as a narcotic, but no basis for this employment has 
ever been discovered in scientific experiments. 



GROUP OF MORPHINE. 45 

PISCIDIA ERYTHRENA was at one time much in vogue in the 
United States as a sleep producer and to check cough, but it was 
recently discovered that its active principle had no narcotic effect 
and in large doses acted much like physostigmine. 

SUMMARY OF THE GROUP ACTION .—Depression of the 
sense of pain before complete narcotic action occurs. Great depres- 
sion of the respiratory centre causing even a measurable decreased 
breathing capacity in small medicinal doses. A tendency to in- 
creased irritability of the cord. Easy acquisition of habit. Increas- 
ing power of oxidation by constant ingestion. Decrease in the move- 
ments of the stomach and intestines and also decrease in the secretion 
of all glands except sweat. Excretion by the stomach and intestines. 

THERAPEUTIC APPLICATION.— On account of the depres- 
sant effect upon the cerebrum, morphine, its derivatives and 
substitutes, are used to arrest pain and to produce sleep, when 
sleeplessness is due to pain, and to quiet other sensory irritations 
such as cough. It frequently gives much relief in asthmatic at- 
tacks. Morphine is used in cases of diarrhoeas to decrease the 
peristalsis and the secretions of the intestines. It is also used to 
stop the movements of the gastro-intestinal tract in cases of in- 
flammations, such as gastritis, enteritis and peritonitis, also in 
cases of hemorrhage from ulcers of the stomach or intestines, and 
lastly in lead poisoning to relieve the intestinal spasm. For these 
conditions, crude preparations of opium are preferable on account 
of their slower absorption and, therefore, more prolonged action. 
Because of its dilating influence upon the peripheral blood vessels, 
morphine is at times used, especially in the form of Dover's 
Powders, to induce sweating. 

When dyspnoea is due to pleurisy, pericarditis or endocarditis, 
and accompanied by much nervousness, opiates may prove of 
great value. 

Morphine and other preparations powerfully depressing res- 
piration should be used only with great care in diseases attended with 
a decrease in the respiratory capacity, as pneumonia. This drug 
should not be given for a long period of time in chronic curable 
or not rapidly fatal diseases, in order to avoid the formation of 



46 CONSTITUTIONAL ORGANIC DRUGS. 

habit. Codeine is used almost exclusively to allay cough in 
such diseases as pulmonary tuberculosis or bronchitis. In such 
cases it is often preferable to morphine because it does not de- 
crease bronchial secretion nor cause as much constipation. It 
cannot be used to influence severe pain on account of its weak 
action. It has been employed in diabetes where it probably acts 
favorably, if at all, by quieting the anxiety of the patient and by 
aiding him to bear better the restricted diet. Heroin, Dionin 
and Peronin have been used for the same conditions as codeine. 
Heroin should be given with great care on account of the depres- 
sion of respiration and tendency to collapse which it causes. 
Crude preparations of Cannabis Indica are very unreliable, as also 
some of the pure principles on the market. It is sometimes em- 
ployed to relieve pain and produce sleep when opium is contrain- 
dicated. Pellotin, has been used to relieve insomnia, but its use 
has been occasionally attended by disagreeable symptoms. 

MATERIA MEDICA. 

Opium (U.S. P., B.P.), inspissated, milky exudation obtained by incising 
the unripe capsules of the opium poppy (papaver somniferum). It is a 
brown resinous mass containing in the (U.S. P.) 9 per cent, and in the (B.P.) 
much less morphine besides a large number of other alkaloids including 
Codeine, Papaverine, Narcotine, Narcein and Thebaine. Dose: — Br. 
(>2-2 grains). Average (U.S.P.) 0.1 G. 

Opii Pulvis (U.S.P.) containing about 12 per cent, morphine. Dose: — 
0.05-0.15 G.; not more than 0.5 in 24 hours. Average (U.S.P.) 0.065 G. 

Extractum Opii (U.S.P.,B.P.), containing 20 per cent, morphine. 
Dose: — 0.01-0.05 G. Br. ($-1 grain). Average (U.S.P.) 0.03 G. 

Pulvis Ipecacuanhae et Opii (U.S.P.), and Pulveris Ipecacuanhae Com- 
positus (B.P.), or Dover's Powder containing 10 per cent, each of powdered 
opium and ipecac. Dose: — 0.3-0.5 G. Br. (5-10 grains). Average 
(U.S.P.) 0.5 G. 

Tinctura Opii (U.S.P., B.P.) or Laudanum containing in (U.S.P.) 10 
per cent, and in (B.P.) much less opium. Dose: — 0.5-1.5 c.c. Br. (10-30 
ttjO- Average (U.S.P.) 0.5 c.c. 

Vinum Opii (U.S.P.). Dose:— 0.5-1.5 c.c. Average (U.S.P.) 0.5 c.c. 

Tinctura Opii Camphorata (U.S.P.) and Tinctura Camphorae Compos- 
itae (B.P.) Paregoric contains 0.4 per cent, opium. Dose: — 5.0-15.0 c.c. 
Br. (1-3 5). Average (U.S.P.) 8 c.c. 

Morphina (U.S.P.), white crystalline alkaloid, with a bitter taste, almost 
insoluble in water, slightly soluble in alcohol. It forms crystalline salts with 
acids, including sulphuric, acetic and hydrochloric acids. These salts, 
Morphinae Sulphas (U.S.P.), Morphinae Acetas (U.S.P., B.P.), Morphinae 
Hydrochloridum (U.S.P., B.P.), are all soluble in water but difficultly soluble 



GROUP OF AMMONIA. 47 

in alcohol. Dose: — Of morphine and its salts, 0.002-0.03 G. Br. (ro-i 
grain). Average (U.S. P.) for morphine 0.01 G. Average (U.S.P.) for 
morphine salts 0.015 G. 

Codeina (U.S.P. , B.P.) or methylmorphine, white crystalline body, 
slightly soluble in H 2 0, easily soluble in alcohol. Dose: — 0.01-0.03. Br. 
(}i~i grain). Its sulphate and phosphate are more easily soluble in H 2 and 
are given in the same dose. Average (U.S.P.) 0.03 G. 

Dimethylmorphine, or dionin, artificial derivative of morphine. Dose : 
— O.OI5 Cr. 

Diacetylmorphine, or heroin, another derivative of morphine. Dose : — 
0.005 G. 

Benzylmorphine or peronin. Dose : — 0.01-0.03 G. 

Cannabis Indica (U.S.P., B.P.), flowering tops of cannabis sativa, Indian 
hemp, a plant growing in Hindustan and used by the natives as an intoxicant 
under the name of Haschisch or Gunjah. It contains the resin cannabinon 
or cannabinol, having narcotic properties, besides the alkaloid tetanocanna- 
bine which has an action similar to strychnine. The latter is present in such 
comparatively small quantities that the action of the crude drug is not in- 
fluenced by it. Dose: — Br. (K _I grain). Average (U.S.P.) 0.065 G. 

Fluidextractum Cannabis Indicae (U.S.P.). Dose: — 0.1-0.3 cc - 
Average (U.S.P.) 0.05 G. 

Pellotina, alkaloid found in a Mexican cactus, Anhalonium Lewinii 
which is prepared by the natives in the form of an intoxicant beverage called 
Mescale. Dose: — 0.01-0.05 G. 

Lactucarium (U.S.P.), concrete, milky exudate of Lactuca Virosa or 
lettuce. No active principle has ever been extracted. Dose: — Average 
(U.S.P.) 1 G. 

GROUP OF AMMONIA. 

AMMONIA and salts of ammonium, possess severe irritant 
properties depending chiefly upon their ease of diffusibility and 
basic nature. On account of this irritant action, redness and 
blisters may result from application to the skin and deep inflam- 
mation and abscesses may occur after subcutaneous injection. Nausea 
and vomiting may take place after too copious internal adminis- 
tration. Inflammation and spasm of the glottis, with death from 
asphyxia, frequently follows the inhalation of large quantities 
of ammonia gas. When smaller quantities have been inhaled, 
death may occur only in several days from capillary bronchitis. 
This local irritant action, when of a mild degree, may reflexly 
stimulate respiration and circulation. 

Intravenous or subcutaneous injections of ammonium com- 
pounds produce a direct stimulation of the central nervous 
system. On account of the stimulation of the medulla, a rise 



48 CONSTITUTIONAL ORGANIC DRUGS. 

in blood pressure and an increase in the force of respiration occurs. 
The great rise of blood pressure and quickening of the pulse, im- 
mediately after an intravenous injection, is due to direct stimu- 
lation of the heart, but the moderate elevation which persists, is 
due to a stimulant action on the medullary centres. Stimulation 
of the cord produces an increase in reflex irritability leading in suffi- 
cient doses to tetanic convulsions. When the dose has been moder- 
ate, these symptoms pass away and the animal recovers, but when 
very large quantities are administered, paralysis of the medullary 
centres results and death occurs in general coma. In frogs, the 
irritant action upon the cord is often masked by the paralyzing 
effect upon the motor end plates. This action, although more 
marked in frogs, may even be present in warm blooded animals 
after the administration of ammonium bases of the fatty acid 
series. 

None of the general actions of ammonia or the simpler am- 
monium compounds are noticed after administration by the 
alimentary tract, because their excretion is so much faster than 
their absorption by this channel, that never enough of the drugs 
are present at one time in the blood to produce an effect. 

Ammonium and its simple salts with organic acids are trans- 
formed by the liver of birds and reptiles into uric acid, and by that 
of mammals into urea. Both of these are excreted by the urine. 
When salts of ammonium with strong mineral acids, such as 
ammonium chloride are administered, the increase of urea in the 
urine is not so great because some of the ammonia must remain 
combined with the acid in order to protect the body from acid 
intoxication. In the case of ammonium chloride, a part of the 
chlorine is excreted by the stomach as hydrochloric acid. On 
account of their transformation in the body before excretion, 
ammonium compounds do not affect the reaction of the urine. 
Some ammonia appears in the sweat and bronchial secretion 
when large doses of the same or its salts are injected subcutane- 
ously or intravenously. Like all alkalies, they dissolve the mu- 
cous secretions with which they come in contact, either in the 
stomach or bronchi. 



GROUP OF AMMONIA. 49 

The different ammonium bases, as Trimethylamin and Cho- 
lin, have more or less the general action of ammonia, but the 
ultimate depressant effect and the curare-like action on the motor 
end plates is more in evidence. 

Summary of the Group Action. — Powerful local irritation 
leading to reflex stimulation of respiration and circulation. Only 
by subcutaneous or intravenous administration, is observed, a 
marked stimulation of medulla, cord and heart, giving rise to in- 
creased circulation, respiration and tetanic convulsions. In cold 
blooded animals paralysis of the motor end plates. Transformed by 
the liver of mammals to urea, by that of birds to uric acid and ex- 
creted chiefly by the kidneys. 

THERAPEUTIC APPLICATION.— Ammonia and salts of 
ammonium are sometimes given subcutaneously or intravenously 
in cases of collapse for their stimulant action on the central nervous 
system. They are more often given internally in the form of 
aromatic spirits of ammonia, or inhaled as smelling salts. By 
this form of administration, the stimulation is only of a reflex 
character and is consequently very transient. 

On account of its local irritant action, ammonia is used in the 
form of liniments as a counterirritant over painful points. Salts 
of ammonium are employed in bronchitis to stimulate and ease 
expectoration. The frequent use of ammonia internally and 
externally for snake bites has no rational support. 

MATERIA MEDICA. 

Aqua Ammoniae Fortior (U.S.P.), a solution of ammonia in water con- 
taining 28 per cent, of the gas by weight. 

Liquor Ammoniae Fortis (B.P.) 32^ per cent, by weight. 

Aqua Ammoniae (U.S.P.) and Liquor Ammonia; (B.P.), a 10 per cent, 
ammonia solution in water. 

Spiritus Ammoniae Aromaticus (U.S.P. , B.P.) or Spirit of Hartshorn, 
contains ammonia, ammonium carbonates, volatile oils and alcohol. Dose : 
— 1.0 to 4.0 c.c. Br. (15-60 ng). Average (U.S.P.), 2.0 c.c. 

Linimentum Ammoniae (U.S.P., B. P.), contains about 3^ per cent, am- 
monia. 

Ammonii Carbonas (U.S.P., B.P.) consisting of a mixture of the carbo- 
nate, bicarbonate and carbamate of ammonium is a translucent crystalline 
mass. Very soluble in water and emits the odor of ammonia. Dose: — 
0.2 to 0.5 G., Br. (3-10 grains). Average (U.S.P.) 0.25 G. 



50 CONSTITUTIONAL ORGANIC DRUGS. 

Ammonii Chloridum (U.S.P., B.P.>, white crystalline powder, with a 
cooling saline taste, freely soluble in water and in 50 parts of alcohol. Dose : 
— 0.2-0.5. Br. (3-10 grains). Average (U.S. P.), 0.5 G. 



GROUP OF STRYCHNINE. 

The typical drug of this group is the alkaloid Strychnine, ob- 
tained from the seeds of Strychnos Nux Vomica, and Ignatia. 
Others are Brucine, also from Strychnos, Calabarine from Cala- 
bar Bean, Gelsemine from Yellow Jasmine, Tetano-Cannabine 
from India Hemp, and Thebaine from Opium. Their similarity 
of action consists of an increase of the reflex activity of the cord, 
leading, in sufficient doses, to tetanic convulsions, which throws 
the body into opisthotonos. 

When large doses of STRYCHNINE have been taken by a man, 
there appears in a very short time, violent tetanic convulsions, 
which grow rapidly in intensity and duration, until there is a 
fixation of the diaphragm in inspiration and death, due to asphyxia 
with consciousness remaining until just before the end. If the 
dose has not been so large, the convulsions may be repeated for 
many hours, elicited and intensified by the least external stim- 
ulation, such as a breath of wind, or the jar of a door, and under 
these conditions, death may take place from exhaustion. If 
the dose is still smaller, there may be only a stiffness of the neck, 
general muscular twitching, and convulsions which are only pro- 
duced by external stimulation. Recovery takes place, leaving 
the subject exhausted and aching all over. That the convulsions 
are due to stimulation of the cord, may be proved by decapita- 
tion of a frog poisoned by strychnine, which will show symptoms 
as marked as if the cerebrum and medulla were intact. Yet, 
there is no doubt that the brain and medulla are also stimulated 
because their functions are intensified. 

On account of the stimulation of the medullary centres there is 
an increase in the strength of respiration and a rise of blood 
pressure. This rise is not entirely due to the effect upon the 
vasomotor centre, but is also, in part, the result of a direct 
action on the vessel walls. There is a great stimulation of the 



GROUP OF STRYCHNINE. 5 1 

special senses ; for the field of vision, the acuteness of hearing 
and of smell, are all increased. 

The increase of vision may first be observed in about three hours 
after the administration of strychnine, but it is most intense 
after five or six hours. Usually it lasts about one day, although 
it may be present several days. It is probably due to direct 
action on the retinal cells, as it is more marked if strychnine 
is injected subcutaneously in the neighborhood of the eye, 
and the effect is seen best on the one near where the injection 
has been made. In man the stimulation of the special senses 
and the medulla precedes that of the cord so that increased reflexes 
and convulsions do not occur while these functions are much in- 
creased, if the dose is not too large. 

Strychnine does not stimulate the heart muscle, but slows 
the rhythm of this organ by stimulation of the vagus. In cold- 
blooded animals as the green frog, it produces after a time, 
a paralysis of the motor nerve endings, just as curare. Occa- 
sionally, man and other warm-blooded animals show the para- 
lytic action on the motor end plates and also paralysis of the 
central nervous system. These effects can only be seen in this 
class of animal when death does not take place early from spasm 
of the respiratory muscles. The paralysis of the central nervous 
system is quite frequently observed in rabbits. 

The habit for strychnine is never formed when fairly good 
doses are given, as the susceptibility does not decrease but rather 
increases by cumulation, due to slow excretion. Occasionally, 
however, when minute doses are given and very slowly increased, 
a considerable degree of tolerance may be reached in some sub- 
jects. 

The treatment of acute poisoning consists of arresting 
the convulsions with ether, chloroform or chloral, then remov- 
ing the poison from the stomach by washing. The volatile anaes- 
thetics are preferable, because if the paralytic symptoms of strych- 
nine supervene, they can be more quickly removed and stimu- 
lants of the central nervous system administered. There is 
practically no hope of recovery when symptoms of paralysis have 
occurred, because the drug is so slowly excreted. 



52 CONSTITUTIONAL ORGANIC DRUGS. 

Strychnine increases the general metabolism, and, therefore, 
the heat production. It also increases the heat dissipation so 
that no rise of temperature is seen, but even a fall, just as 
after other convulsive agents. It is excreted very slowly by 
the kidneys, and because of this slow excretion small amounts 
may become stored up in the body until they have accumulated 
to a poisonous dose. For this reason, the therapeutic adminis- 
tration of strychnine for any length of time should always be in- 
terrupted for a period when none is given, in order to allow suffi- 
cient time for excretion. 

Like most other alkaloids, it has a local irritant action, 
which shows itself when given internally, by an improvement of 
the appetite, an increase in the digestive juices and in the move- 
ments of the stomach and intestines. Sufficiently large doses 
may cause nausea, vomiting and diarrhoea. 

The other alkaloids, Brucine, Gelsemine and Thebaine are 
much weaker than strychnine. Brucine and thebaine are more 
apt to show earlier symptoms of depression of the central ner- 
vous system. 

SUMMARY OF THE GROUP ACTION.— Great increase in the 
reflex irritability of the cord leading to tetanic convulsions. Earlier, 
and with small doses, stimulation of the medullary centres with in- 
crease in the respiration and circulation. Stimulation of the special 
senses, of sight, hearing, smell, taste and touch. When death is not 
produced by fixation of the diaphragm with very large doses, paral- 
ysis of the central nervous system and in cold-blooded animals, of 
the motor end plates. Slowing of the heart by stimulation of the 
vagus centrally, but no stimulation of the heart muscle. No habit 
formation, but cumulative effects on account of slow excretion which 
takes place by the kidneys. 

THERAPEUTIC APPLICATION.— The bitter taste and local 
stimulant action of strychnine are used in medicine to improve 
the appetite, increase the secretions of digestive juices and the ab- 
sorption of food in malnutrition from chronic diseases or in the 
convalescence from acute sickness. For this purpose, the crude 
preparations of nux vomica are more suitable than the crystalline 



GROUP OF STRYCHNINE. 53 

alkaloid, because they are less readily absorbed and remain for 
a longer time in contact with the gastro-intestinal tract. Strych- 
nine is used to improve the respiration and to raise the blood 
pressure in collapse from injuries, or from the action of the 
narcotic poisons, as in chloral poisoning or during ether or 
chloroform anaesthesia. It is employed in the treatment of 
different forms of pareses and paralyses; such as those occurring 
in neuritis due to lead or alcohol, or in injuries or diseases of the 
cord or in cerebral hemorrhage. The best results are obtained in 
partial paralysis, especially of the sphincters of the bladder or anus 
when all the nerve fibres are not degenerated, and also, when an in- 
flammatory stage is passed, for it may increase the irritation of 
nerve tissues. It is to be avoided in fresh hemorrhage from the 
brain, as by increasing the blood pressure it might increase the 
bleeding. 

It is often useful in optic atrophy and is best injected in the 
temple in the neighborhood of the affected eye every two or three 
days. It may prolong vision in slow running cases, for a period 
of a few years, by keeping the healthy optic fibres stimulated to 
increased perception. Naturally, in these cases it is in no sense a 
cure, as the vision is as poor as ever when its use is discontinued. 

MATERIA MEDICA. 

Nux Vomica (U.S.P.,B.P.), seeds of Strychnos Nux Vomica, a tree 
growing in India and Malay Peninsula. They should contain 1.25% strych- 
nine. Dose: — Average (U.S.P.) 0.065 G. Br. (1-4 grains). 

Extractum Nucis Vomicae (U.S.P., B.P.). Dose: — 0.01-0.05 G. Br. 
(}i~i grain). Average (U.S.P.) 0.015 G. 

Fluidextractum Nucis Vomicae (U.S.P.). Dose: — 0.05-0.25 c.c. 
Average (U.S.P.) 0.05 c.c. 

Tinctura Nucis Vomicae (U.S.P., B.P.). Dose: — 0.3-1.0 c.c. Br. 
(5-15 mO- Average (U.S.P.) 0.6 c.c. 

Strychnina (U.S.P. ,B.P.), white crystalline, alkaloid, very insoluble in 
water, slightly soluble in alcohol, soluble in ether and chloroform. It forms 
salts with acids. It is intensely bitter so that its taste may be detected in the 
dilution of 1 to 700,000. Dose: — 0.001-0.01 G. up to 0.02 G., in 24 hours; 
0.03 G. has proved fatal. Average (U.S.P.) 0.001 G. (Br. ^V~xs grain.) 

Strychninae Sulphas (U.S.P.), white crystalline, soluble in 50 parts of 
water, less soluble in alcohol. Dose: — 0.001 to 0.01 up to 0.02 G., in 24 
hours. Dose: — Average (U.S.P.) 0.001. 

Strychninae Hydro chloridum (B.P.). Dose: — (Br. sV~rs grain). 



54 CONSTITUTIONAL ORGANIC DRUGS. 

GROUP OF PICROTOXIN. 

The most important substances which compose this group 
are Picrotoxin, the fish poison, Digitaliresin and Toxiresin from 
Digitalis, Samandarin from Salamanders, Coriamyrtin, Cicutoxin 
and Oleandresin. 

PICROTOXIN shows its typical action in the form of clonic 
convulsions, due to stimulation of the medulla, and thus differs 
from strychnine which produces tetanic attacks by stimulating 
the cord. The stimulation of the centres in the medulla also 
produces deep and even convulsive respirations, a rise of blood 
pressure, a slowing of the pulse, vomiting and salivation. It is 
said that the cord is also stimulated and that the reflex irritability 
is increased, yet this action is insignificant compared to that on the 
medulla, as the convulsions are typically clonic and do not appear 
in a characteristic form in frogs after destruction of the medulla. 

The heart itself is but little affected by picrotoxin, for the 
slowing of the pulse is due to stimulation of the vagus centre in the 
medulla, and although the heart is stopped in diastole in frogs, 
the standstill may be relieved by section of the vagus. The 
increase in blood pressure is exclusively the result of stimulation 
of the vasomotor centre. 

The respiration is at first markedly stimulated through its 
centre, then it becomes convulsive, and lastly slowed and labored, 
due to ultimate central paralysis. 

The use of picrotoxin for catching fish depends upon a spasm- 
like contraction of the outlet to their air bladders. These dis- 
tended air sacs act like balloons and buoy up the animal so that 
he cannot get under water, then he may easily be gathered in 
nets. Almost the same condition is observed in frogs whose lungs 
become greatly distended with air on account of a spasmodic 
closure of the glottis. 

The mother substance of CICUTOXIN or Cicuta Virosa, has 
given rise to cases of poisoning by being confounded with flavoring 
herbs, or eaten by children. The toxic symptoms are vomiting, 
pain in the abdomen, muscular tremor, convulsions of an epilep- 



GROUP OF CAMPHOR. 55 

tiform character, quickened and labored respiration, unconscious- 
ness and death. 

SAMANDARIN, the poison obtained from the skin of salaman- 
ders, gives rise to symptoms in dogs which closely resemble hy- 
drophobia and consist of great salivation, increased mucous secre- 
tion, convulsive respirations with a mixture of clonic and tonic 
convulsions, and lastly death through general paralysis. It pro- 
duces a small rise of blood pressure and a slowing of the pulse. 
All these symptoms closely resemble those elicited by picro- 
toxin and are the result of stimulation of the medulla, also to 
a minor degree of the cord. 

SUMMARY OF GROUP ACTION .—Stimulation of the medul- 
lary centres producing an increase in the respiration and blood pres- 
sure, a slowing of the pulse, vomiting and convulsions of a clonic or 
epileptiform character. 

THERAPEUTIC APPLICATION.— Pier otoxin has been rec- 
ommended as a respiratory stimulant, but its other and undesir- 
able actions are too prominent to warrant this as a regular ap- 
plication. It was recommended by one authority to arrest 
the night sweats of phthisis and of other exhaustive diseases, on 
the theory that the latter were due to improper respiratory func- 
tions which might be improved by picrotoxin. It has also been 
used in the form of an ointment to destroy pediculi on the body. 

MATERIA MEDICA. 

Picrotoxinum (B.P.), a neutral principle, soluble in alcohol and only 
slightly in water, obtained from Anamirta Panniculata which is used ex- 
tensively in India as a fish poison. Dose: — 0.001-0.003 G. Br. ( go ■ 2 
grain). 

GROUP OF CAMPHOR. 

The main and most important action of CAMPHOR is the re- 
sult of stimulation of the nervous system, and especially of the 
centres in the medulla and brain. The constitutional action of 
this drug is slow to appear, on account of its difficult absorption, 
due to the fact that it is practically insoluble in the body fluids. 

When a large dose is ingested by man, it produces at first, a 



56 CONSTITUTIONAL ORGANIC DRUGS. 

burning sensation in the stomach, and sometimes nausea and 
vomiting. This stimulation of the gastro-intestinal tract is fol- 
lowed by a general sensation of warmth, headache, mental con- 
fusion and excitement, and an increase in the force of the pulse, 
with a slowing in its rate. 

In warm-blooded animals, camphor stimulates the centres of 
the medulla. On account of the stimulation of the respiratory 
centre, the amplitude and frequency of the respirations may 
be considerably increased. The action on the vasomotor centre 
brings about a rise in the blood pressure. This rise is not ex- 
clusively due to the effect on the centre, but is in great part the 
result of a direct stimulation of the heart muscle, as from the 
action of physostigmine. The epileptiform convulsions, some- 
times observed after the administration of camphor in mammals, 
recur at varying intervals, and last from five to ten minutes. 
Usually after a few hours they cease and the animal recovers 
completely. These convulsions are probably due to a stimulant 
effect on the cerebral cortex, because, after the removal of the 
latter they do not occur. A slight degree of narcosis is some- 
times observed in mammals, but the stimulant effect is usually 
paramount. 

In the lower forms, such as frogs, moth, insects, moles and bac- 
teria, camphor exerts a purely depressant action. Frogs become 
paralyzed exactly the same as from ether, and later these animals 
show a paralysis of the motor nerve endings. If the dose has 
been small they recover, if large, they die from general paralysis. 
On account of its depressant action on the lower vegetable forms, 
camphor is a disinfectant. 

It lowers the body temperature when pathologically in- 
creased. Locally, it produces a severe irritant effect which is 
followed by a feeling of cold and anaesthesia. This local irri- 
tant action makes itself evident by severe pain at the point of 
application when camphor is given subcutaneously, and by irri- 
tation of the stomach and vomiting when it is given by the mouth,. 
It is partially oxidized in the body to camphoral, but it is excreted 
by the urine as camphoglycuronic acid. 



GROUP OF CAMPHOR. 57 

The other STEAROPTENES (camphor-like bodies), Borneol, 
Camphoroxim, Camphor monobromate, Menthol and Thymol, 
have to some extent the action of camphor, but they do not stim- 
ulate the heart and they ultimately depress the central nervous 
system. They paralyze more markedly the motor nerve endings 
in frogs. Menthol has an especially strong depressant action on 
the sensory nerve endings, and therefore, is a good analgesic. 
Thymol has very strong antiseptic and antiparasitic action, and 
its toxic effects are particularly marked on the hookworm. 

Camphoric Acid is mentioned by most authors as having the 
same effect on the nervous system as camphor, but in addition, as 
producing a paralysis of the nerves supplying the sweat glands 
just like atropine. This opinion is entirely wrong, as camphoric 
acid is almost devoid of action. Eight grammes may be given 
subcutaneously in the form of sodium salts to a rabbit, without 
eliciting any symptoms. Such quantities injected into a vein, 
cause no action upon either the respiration or circulation. Cam- 
phoric acid fails to show the slightest effect upon the secretion of sweat 
even in the most careful experiments. 

SUMMARY OF THE GROUP ACTION .—Intense stimulation of 
the respiratory and vasomotor centres in the medulla, and increase 
in force of the heart muscle with resulting augmentation of the 
respiration and circulation. Later, stimulation of the cortex in 
higher animals with resulting clonic convulsions. Sometimes, 
in warm-blooded animals depression of the cerebrum with sleep 
following, but in very low organisms depression of the entire ner- 
vous system is almost the only action. Local irritation followed 
by local anaesthesia. Excretion through the kidneys, after com- 
bining with glucuronic acid. 

THERAPEUTIC APPLICATION.— Camphor is used in cases 
of collapse, on account of its stimulant effect upon the respiratory 
centre and upon the heart. This use is not always attended by 
success, because of the irregular and slow absorption of cam- 
phor even after subcutaneous administration. Besides this 
latter method is not very practical, due to its severe local irritant 
properties. It is used as an analgesic wash in skin diseases to 



58 CONSTITUTIONAL ORGANIC DRUGS. 

allay itching, also over wounds and ulcers as an antiseptic. For 
local analgesic effect Menthol is especially applicable, and has 
been used in the form of a stick rubbed over the temple and face 
for neuralgia. Camphoric acid is used to decrease sweat, 
especially in Phthisis, but without reason. Camphor mono- 
bromate is used as a sedative in conditions of nervous excitement 
and to decrease sexual irritability. 

MATERIA MEDICA. 

Camphora (U.S.P., B.P.) a stearoptene, obtained by the sublimation 
of cinnamomum camphora, a tree growing in China and Japan. It is a white 
crystalline body with burning, bitter taste and characteristic odor, and is 
soluble in alcohol, ether, chloroform and oils, only very sparingly in water. 
It liquefies when rubbed with thymol, phenol, menthol and chloral. Dose : 
— 0.1-0.2 G. up to i.o G., in 24 hours. Br. (2-20 grains). Average (U.S.P.) 
0.125 G. 

Aquae Camphorae (U.S.P., B.P.). Dose :— 5.0-10.0. Br. (1-2 fl. 5). 
Average (U.S.P.) 8.0 c.c. 

Spiritus Camphorae (U.S.P., B.P.) 10 per cent. Dose: — 1.0-2.0 Br. 
(15-30 ttj/). Average (U.S.P.) 1.0. 

Linimentum Camphorae (U.S.P.). 

Camphora Monobromata (U.S.P.) is a bromine substitute of camphor 
with almost the same solubility. Dose: — 0.1-0.2. Average (U.S.P.) 
0.125 G. 

Acidum Camphoricum (U.S.P.), oxidation product of camphor, soluble 
in alcohol and slightly so in hot water. Dose : — 0.5-2.0 c.c. Average (U. 
S.P.) 1.0 G. 

Menthol (U.S.P., B.P.) a secondary alcohol from Oleum Menthae Piperita?. 
It is a white crystalline body with aromatic odor and burning taste: slightly 
soluble in water, but easily soluble in alcohol, ether and oils. It liquefies 
when rubbed with camphor, thymol, and chloral. Dose: — 0.05-0.1. Br. 
(1-2 grains). Average (U.S.P.) 0.065 G-. 

Thymol described under the Group of Phenol. 



GROUP OF CAFFEINE. 

This group consists of a number of chemically related sub- 
stances extracted from plants of various families, which have 
been used for centuries as subsidiary articles of diet in different 
countries. The chief member, the alkaloid caffeine, is present 
in the coffee bean, in the Chinese tea leaves, in the cocoa bean, in 
mate or Paraguay tea, in Apalachian tea, in the kola nut of Central 
Africa, and lastly in guarana, a beverage prepared in Brazil 
from Paulinia fruits. Other members of the group allied to 



GROUP OF CAFFEINE. 59 

caffeine, both chemically and pharmacologically, are theo- 
bromine found in the kola nut and cocoa bean, theophylline 
found in tea leaves, and different xanthin bases found in the 
urine of animals. 

CAFFEINE stimulates the entire central nervous system, 
and thereby produces in man, in small doses, an increased capacity 
for mental work, in larger doses, dizziness, headache, ringing in the 
ears, restlessness, sleeplessness and even delirium. In the 
lower animals, it increases the reflex irritability of the cord very 
markedly, and produces, in sufficient doses, convulsions of either 
clonic or tetanic character. It stimulates the vasomotor 
centres in the medulla, and causes a rise of blood pressure. It 
also increases the functional activity of the respiratory centre. 
In dogs and cats, caffeine usually causes at first, vomiting and 
defecation, then tetanic convulsions, and lastly, death due to 
paralysis of the central nervous system and heart. 

When this drug is injected directly into a muscle or into the 
artery going to a muscle, the latter becomes opaque, white and 
hard, as in rigor mortis. If the quantity applied is very small, 
only an increase in the force of contraction and in the capacity 
for work is noticed. This action partly explains the well known 
beneficial effect of caffeine upon men performing strenuous phys- 
ical exercise, as long marches. 

The muscles of the heart are stimulated, thus producing an 
increase in the force and usually in the rate of contraction. Oc- 
casionally the pulse rate is decreased, probably by stimulation of 
the vagus centre in the medulla. The value of the action on 
the heart is much decreased by the great irregularity of rhythm, 
which caffeine often produces. If the drug is injected intraven- 
ously, in large quantities, dogs, cats, and rabbits die from cardiac 
paralysis. 

The increased micturition which is seen in man after the 
ingestion of caffeine, has also been observed in experimental an- 
imals, in which the secretion of urine may be increased several 
hundred per cent, above the normal. This diuretic action is not 
due to the increase in blood pressure alone, but is the result of a 



60 CONSTITUTIONAL ORGANIC DRUGS. 

direct stimulation of the secreting parenchyma of the kidney, and 
is always accompanied by a dilatation of the smaller blood ves- 
sels of this organ. The height of the diuresis varies in direct 
proportion to the dilatation of the renal smaller vessels, and at 
times, no diuretic action takes place when the blood supply of 
the kidneys is decreased by stimulation of the central nervous 
system, until the contracted vessels are dilated by some drug, as 
chloral. The urine contains only a small percentage of the caf- 
feine ingested, but a considerable increase of the other xanthin 
bases, which are undoubtedly derived from it. 

Caffeine does not increase nitrogenous metabolism, but 
may cause a greater excretion of carbon dioxide on account of 
the augmented muscular work which may be performed under 
this drug. It may raise slightly the body temperature. Chronic 
poisoning occurs in animals when caffeine is introduced by any of 
the channels of absorption. The gastro-intestinal tract suffers 
much, even if the drug is administered subcutaneously. Animals 
exhibit vomiting and diarrhoea and at autopsy marked inflamma- 
tion of the stomach usually acompanied by ecchymoses. Much 
emaciation usually occurs before death. 

A cup of coffee or of tea which contains 0.1-0.2 G. of caffeine 
may be taken with meals by most individuals without poisonous 
effects. Large quantities of either, however, are liable to pro- 
duce headaches, palpitation and mental confusion and when 
excessive quantities are used over a long period of time, nervous- 
ness, gastric and intestinal disturbances, and irregularity of the 
heart may be noticed. 

THEOBROMINE has little effect on the heart and nervous sys- 
tem, but it acts on the muscles as intensely as caffeine. It is the 
diuretic par excellence because its action is lasting and powerful, 
and in doses sufficient for diuresis, does not affect other organs, 
except that it occasionally causes a little irritation of the gastro- 
intestinal tract. Theobromine has a diuretic action more con- 
stant than that of caffeine because it never contracts the smaller 
renal vessels centrally, but always produces a marked dilatation. 
This dilatation is said to be of value in renal affections, by im- 



GROUP OF CAFFEINE. 6 1 

proving the circulation of the kidney. The total albumen in the 
urine of patients with Blight's Disease has been found less under 
theobromine. 

THEOPHYLLIN acts upon the central nervous system very 
much like caffeine. It has less action upon the heart, but is more 
apt to produce gastro-intestinal disturbances. Its diuretic effect 
is tremendous momentarily but of very short duration. 

SUMMARY OF THE GROUP ACTION.— Intense stimulation 
of the central nervous system, especially of the brain and medulla, giv- 
ing rise to an increase in mental activity, also increase in the effi- 
ciency of the respiration and circulation. Stimulation of the cord 
which may lead to tetanic convulsions, best seen in the lower grade of 
animals. Stimulation of the renal functions by direct action on the 
kidneys. Increase in the force of contraction of the heart sometimes 
accompanied by irregularity of the pulse. Direct stimulation of the 
striated muscles leading to increased capacity for work, while 
with large amounts directly applied, permanent rigor with changes 
in the histological texture of the muscles. 

THERAPEUTIC APPLICATION.— Both Caffeine and Theo- 
bromine are used with good results on account of their diuretic 
action in cases of heart and liver dropsy to help the elimination of 
the accumulated fluid. The use of these substances in Bright's 
Disease, is sometimes attended with less beneficial results, be- 
cause the renal epithelium may be destroyed to such an extent 
that it is incapable of being stimulated. In this latter condition 
they are also liable to increase the irritation. Theobromine is 
used in preference to caffeine as a diuretic, because it is. more 
powerful, and because it does not stimulate the cord nor con- 
tract the vessels of the kidney. 

Caffeine is given in cases of narcotic poisoning and collapse, 
because of its stimulant effect on the respiration and heart. 

In nervous exhaustion it may be useful because of its general 
stimulant action upon the central nervous system. Its use in 
migraine, wiiich is sometimes beneficial and sometimes harmful, 
cannot as yet be explained. 



62 CONSTITUTIONAL ORGANIC DRUGS. 

MATERIA MEDICA. 

Caffeina (U.S.P., B.P.), is a mildly basic substance obtained from the 
tea leaves and coffee bean but is also present in many other plants. It is 
present to the extent of about 0.12 gram in a good cup of coffee made from 
15 grams of coffee or in a cup of tea made from 5 grams of tea leaves. It is 
a white crystalline substance with bitter taste, difficultly soluble in water. 
It forms easily soluble double salts with sodium salicylate and sodium 
acetate. Dose: — 0.2 G. per day up to 0.6. Br. (5 grains). Average 
(U.S.P.) 0.065 G. 

Caffeina Citrata (U.S.P.) and Caffeina Citras (B.P.), white powder, de- 
composed by warm water, soluble in three parts of water, composed of a 
loose combination of citric acid and with caffeine. Dose: — 0.1-0.5 G. 
Br. (2-8 grains). Average (U.S.P.) 0.125 G. 

Caffeina Citrata Effervescens (U.S.P.) or Caffeinae Citras Effervescens 
(B.P.), a mixture of sugar, sodium bicarbonate and citric acid containing 4 
per cent, caffeine in the (U.S.P.) and 2 per cent, in the (B.P.). Dose: — 
1-10 G. Br. (15-150 grains). Average (U.S.P.) 4.0 G. 

Theobromina, crystalline powder, very difficultly soluble in water. 
Dose: — 0.5 G. 

Theobromine Sodio-Salicylas, or diuretin, is a white powder easily 
soluble in water and containing 50% theobromine. It changes color and 
gradually decomposes on standing. Dose : — 1.0 G. 

Theobromine Sodio-Acetas, or agurin, double compound of theo- 
bromine and sodium acetate; very soluble in water. Dose : — 1.0 G. 

Theobromine Sodio-Formas, or theophorin. Dose: — 0.5 G. 

Theophyllina, white, crystalline body, difficultly soluble in water. 
Dose: — 0.2-0.4 G. 

Fluidextractum Guarana. Dose: — 3.0-8.0 c.c. 

GROUP OF HYDROCYANIC ACID. 

HYDROCYANIC ACID or Prussic acid is one of the most 
rapidly acting poisons. After a large dose has been taken by 
man or lower animals, they may fall lifeless to the ground in a 
few seconds without any premonitory symptoms, except, perhaps, 
a scream and a few convulsions. 

When smaller doses of the acid or of its simple salts such as 
the cyanides of potassium, sodium and mercury are ingested, the 
subject begins to show an increase in the frequency of the respira- 
tion, also a rise of the blood pressure, with restlessness and mus- 
cular twitching. These symptoms are soon followed by clonic 
convulsions, unconsciousness, dilatation of the pupils, diminution 
in the force and frequency of respiration, and fall of blood pres- 
sure. The respirations become progressively fewer until death 
takes place by asphyxia. 



GROUP OF HYDROCYANIC ACID. 63 

Human beings who have taken a small poisonous dose, experi- 
ence a burning, bitter taste, a numbness in the mouth and throat, 
an increase in the salivary secretion, then a feeling of oppression 
in the chest with pain over the heart and dyspnceic respirations. 
After an increase in these symptoms they die, as do the lower 
animals, with convulsions and loss of consciousness. 

The symptoms are due to a primary stimulation of the cen- 
tral nervous system followed by paralysis of the same. Hence 
the respiratory, vasomotor and vagus centres are first stimulated, 
then depressed. The convulsive attacks are probably due to a 
stimulation of the centre of convulsion. 

The heart is depressed chiefly through its motor ganglia, as its 
musculature remains irritable to electricity long after the organ 
has stopped beating. After moderately large doses, the re- 
spiratory centre is paralyzed before the heart, as resuscitation 
may sometimes be brought about by artificial respiration when 
breathing has practically ceased. Enormous quantities may 
arrest both the heart and respiration at the same time. 

Hydrocyanic acid forms a loose combination with the oxy- 
hemoglobin of the blood and decreases its oxidative powers. 
Thus, the blood in the veins may retain its oxygen and look 
bright red like that of the arteries. The formation of a loose 
compound with haemoglobin in the living body is not of great 
significance in explaining the poisonous action of hydrocyanic 
acid because it produces the same toxic effect on animals with- 
out any haemoglobin, and also in frogs whose blood has been 
replaced by salt solution. It yields a compound with methaemo- 
globin which has a bright cherry-red color. To this combina- 
tion, is due the peculiar post-mortem appearance of the blood in 
dependent parts of victims of prussic acid poisoning. 

The metabolism is much decreased by this drug, therefore, 
less oxygen is absorbed and less carbon dioxide excreted, than 
normally. This may be due to its general effect on protoplasm, 
for hydrocyanic acid can be considered in many respects a 
general protoplasmic poison, because it affects markedly the 



64 CONSTITUTIONAL ORGANIC DRUGS. 

functions of the lower organisms. It even stops the action of 
certain unorganized ferments. 

Hydrocyanic acid and simple cyanides are excreted, to a cer- 
tain extent, by the kidneys as sulpho compounds. 

Locally applied, a solution of the acid depresses the endings of 
the sensory nerves and, therefore, decreases sensibility, but after 
internal administration, no such results are to be observed. 

Some cases of poisoning occasionally occur in chemical labora- 
tories, following the inhalation of the fumes of this terrific poison. 
Others result from suicidal attempts by scientific men, as chemists 
and doctors, who choose this drug on account of its rapid action. 
In presence of such cases, the chief method of treatment consists 
of artificial respiration. The poison is rapidly transformed in the 
body and when respiration is maintained recovery may take 
place if the dose has not been large enough to paralyze the heart. 
The best hope of success is in cases of accidental inhalation of 
the gas, for after the suicidal ingestion, the dose is as a rule so 
overwhelming that nothing can be done. 

SUMMARY OF THE GROUP ACTION.— Intense depression 
of the different centres in the medulla especially that of respiration, 
after a brief stimulation. The motor ganglia of the heart paralyzed 
directly by a large dose. Stimulation of the convulsive centre. 
Formation of a loose compound with hcemoglobin which reduces 
its oxidative properties. Paralysis of all forms of protoplasm 
and even arrest of the action of some unorganized ferments. By 
local application, paralysis of the sensory nerve endings, with anal- 
gesic effect. 

THERAPEUTIC APPLICATION.— The use in medicine of 
hydrocyanic acid and its salts has properly become obsolete. 
They possess no desirable action, and considerable danger. The 
acid in 2 per cent, solution was formerly employed to check the 
cough in phthisis and to allay the pain in some affections of the 
stomach. Nowadays, we have much safer drugs for these purposes 
and only employ as flavoring agents, preparations of wild cherry 
and bitter almonds which contain traces of hydrocyanic acid. 



GROUP OF CARBON MONOXIDE. 65 

MATERIA MEDICA. 

Acidum Hydrocyanicum is a colorless liquid with the odor of bitter 
almonds. It forms simple salts with sodium, potassium, mercury and silver 
which are all decomposed in the body with the formation of free hydrocyanic 
acid and, therefore, have identical action with this acid. The double salts, 
ferro and ferri cyanides of sodium or potassium, are not decomposed in the 
body and, therefore, do not have the same action as hydrocyanic acid, but 
merely act as purgatives. The nitrocyanide of sodium is a double salt which 
by exception is decomposed in the body and has a typical cyanide action. 
Hydrocyanic acid occurs native in a number of plants. It is formed by 
the decomposition of Amygdalin, by dilute acids, or by a ferment Emulsin. 
Both Amygdalin and Emulsin are present in bitter almonds and wild cherry 
and in the seeds of other fruits, but the amount of hydrocyanic acid liberated 
is not, as a rule, sufficient to be poisonous. 

Acidum Hydrocyanicum Dilutum (U.S.P.,B.P.), is a 2 per cent, solu- 
tion of hydrocyanic acid. It is a colorless 1 liquid with the characteristic 
odor. Dose: — 0.1-0.5 c - c - Br. (2-8 ttjj). Average (U.S.P.) 0.1 c.c. 

Prunus Virginiana, bark of wild cherry. 

Fluidextractum Pruni Virginianae (U.S.P.). Dose: — 2.0-4.0 c.c. 
Average (U.S.P.) 2.0 c.c. 

Infusum Pruni Virginianae (U.S.P.). Dose: — 15.0-60.0 c.c. Aver- 
age (U.S.P.) 60 c.c. 

Syrupus Pruni Virginianae (U.S.P.). Dose: — 5.0-15.0 c.c. Aver- 
age (U.S.P.) 4.0 c.c. 

Amygdala Amara, kernels of bitter almonds. 

Aqua Amygdalae Amarae (U.S.P.). Dose: — 5.0-15.0 c.c. Average 
(U.S.P.) 4.0 c.c. 

Spiritus Amygdalae Amarae (U.S.P.). Dose: — 1.0-2.0 c.c. Aver- 
age (U.S.P.) 0.5 c.c. 



GROUP OF CARBON MONOXIDE. 

This group contains only CARBON MONOXIDE, the chief 
toxic agent of illuminating gas. Unlike hydrocyanic acid, 
the characteristic action is dependent upon its combination with 
the hemoglobin of the blood because it has no influence on animals 
without haemoglobin and it does not seem to interfere with lower 
states of protoplasm. 

If forms with haemoglobin a very stable compound which 
cannot act as an oxygen carrier, therefore, when enough has en- 
tered the system, there occurs asphyxia of all the tissues. To this 
action, all the symptoms of poisoning are referable. The blood 
has a purplish-red hue which does not change when shaken with 
air, as does ordinary venous blood. The quantity of carbon 
monoxide combined with haemoglobin does not seem to depend 
5 



66 



CONSTITUTIONAL ORGANIC DRUGS. 



upon the total quantity respired, but upon the partial pressure. 
When the quantity is very small, it remains dissolved in the plasma 
and does not combine with haemoglobin. The combining power 
of carbon monoxide bears a certain relation to its concentration 
as expressed in the following table which has been prepared by 
Hiifner to show this proportion: 



Percentage of carbon monoxide 
in air of respiration 

o.oi 

0.025 

O.I 

0.5 

1.0 

2.0 
3-o 



Percentage of carbon monoxide 
haemoglobin in blood. 

6.83 
15-5 
42.0 
78.65 
86.0 
93-72 
95-o 



When air containing from 0.02 to 0.024 P er cent, of carbon mon- 
oxide is inhaled by man, no poisonous symptoms occur as long as 
that proportion is not increased. With concentrations of 0.4 to 
0.5 per cent., i. e., when about 70 per cent, of the haemoglobin has 
been combined with this gas, death takes place with stoppage of 
respiration. 

Carbon monoxide is not oxidized in the body. It is gradually 
dissociated from the haemoglobin, and travels dissolved in the 
plasma. It is excreted by the lungs. The separation of carbon 
monoxide from haemoglobin is more rapid in dogs than in men. 
A dog made unconscious by carbon monoxide may recover with- 
in ten or fifteen minutes, while a man may remain in coma for 
hours. 

The symptoms of poisoning in animals consist, at first, of 
quickening of the pulse and respiration, great restlessness, con- 
vulsive contraction of the head and limbs and at last well-marked 
convulsions and death. Glycosuria usually occurs and is prob- 
ably due to interference with the respiratory processes. 

In human beings, the toxic symptoms can be divided into 
three stages: in the first, there are headache, knocking in the head, 
roaring in the ears, dizziness, difficulty in breathing, palpitations, 
reddening of the face and mucous membranes, nausea and vomit- 
ing and loss of consciousness; in the second, there occurs a 



GROUP OF ATROPINE. 67 

series of clonic convulsions of greater or lesser intensity; in 
the third, general paralysis with relaxation of the sphincters of 
the bladder and anus, and very weak respiration and heart beat, 
until both cease. 

When the subject is removed from the poisonous atmosphere 
and given fresh air, in the first stage, he invariably recovers; in 
the second stage, recovery is also frequent, but in the third stage, 
the patient usually dies. When recovery does take place in the 
third stage, it may be complete and immediate, or it may leave, 
for a considerable time, different complications, as paralysis of the 
limbs, of the sphincters, loss of speech, blindness and disturb- 
ances of cerebration. 

The treatment of poisoning is self evident and consists of 
placing the patient in pure fresh air and administering artificial 
respiration. Lately blood transfusion has been advocated and 
found of service experimentally. 

SUMMARY OF THE GROUP ACTION.— The formation of a 
very difficultly decomposed compound with hcemoglobin which inter- 
feres with respiration and gradual death of the tissues. The symp- 
toms divided into three stages: firstly, unpleasant sensations; sec- 
ondly, convulsions from asphyxia; and thirdly, general paralysis 
and death. 

GROUP OF ATROPINE. 

This group is composed of various alkaloids extracted chiefly 
from plants of the Solanacae family. The principal ones are 
atropine, hyoscyamine and scopolamine. The different members 
of this group resemble atropine closely, both in chemical com- 
position and in pharmacological action. 

ATROPINE depresses the nerve terminations of secretory 
glands, of smooth muscle fibers, and of inhibitory apparatuses. 
On the central nervous system, it produces a stage of stimulation 
which is followed by one of depression. 

The first symptoms observed in man consist of a sensation 
of dryness and irritation of the throat, thirst and difficulty 
in swallowing, all of which result from the decreased formation 



68 CONSTITUTIONAL ORGANIC DRUGS. 

of saliva and mucus. The skin becomes dry, hot and red. 
Nausea and vomiting may occur. The pupils dilate and the 
power of accommodation is lost. The pulse is full and 'rapid, 
due to a rise in blood pressure resulting from the stimulation 
of the vasomotor centre and from the paralysis of the inhibitory 
vagus. The subject is at first excited, delirious and maniacal. 
The stimulation of the brain which brings about these symptoms 
is soon replaced by depression, causing decreased consciousness 
and later deep coma. 

Besides the secretory nerves of the sweat and salivary glands, 
those of the bronchi, stomach, intestines, pancreas, liver and 
mammae are depressed, with a resulting decrease in the secretions 
of these organs. Both the total quantity of the gastric juice and 
also the percentage of hydrochloric acid is diminished. 

The inhibitory apparatuses of the vagus and splanchnics 
are paralyzed, with a consequent increase in the rate of heart beat 
and in the peristalsis of the intestines. The movements of the 
latter are afterwards decreased by a paralysis of the motor nerve 
supply to their smooth muscle fibres, and with very large doses, 
by a paralysis of the muscles themselves. 

Depression of the motor nerve endings of the smooth muscle 
fibres of the bladder, ureters, uterus, spleen and oesophagus, de- 
creases the power of contraction of these organs. It is said that 
the sensory endings are also depressed. 

The pupils are widely dilated and accommodation and adapta- 
tion of the eye are both paralyzed on account of the depression of 
the oculomotor nerve endings in the ciliary and iris muscles. 
This action is best seen after local application. The intro- 
duction of one drop of a i per cent, solution in the eye, dilates 
the pupil and paralyzes accommodation in about one and a half 
hours. Paralysis of accommodation may last four or five days, 
while dilatation of the pupil may be observed after one week. 
The intraocular pressure is raised, because the dilated iris ob- 
structs the canal of Schlemm, which assists in the draining of 
the eyeball, and because the blood vessels in the eye are dilated. 

Stimulation of the cerebrum shows itself by excitement and 



GROUP OF ATROPINE. 69 

delirium. The primary stimulation of the respiratory and vaso- 
motor centre in the medulla brings about an increase in the force 
of respirations and a rise of blood pressure. Only the larger in- 
ternal blood vessels are contracted, for those of the skin, surface 
of the brain, and of the eye, are dilated. Stimulation of the cen- 
tral nervous system is followed by depression. The latter causes 
unconsciousness, fall in blood pressure and death from respiratory 
failure. Large doses, applied locally to the heart, not only paral- 
yze the vagus, but also the cardiac muscles themselves. At 
first, only a great increase in the rate of heart beat takes place, 
but later the force of the heart's contraction is decreased until 
complete arrest occurs. 

Atropine produces a rise of temperature, probably through 
the heat regulating centres. It is in great measure oxidized 
in the body, although a smaller portion is excreted in the urine. 

HYOSCYAMINE resembles atropine very closely in its action. 
It differs from the latter, as it usually depresses the cerebrum from 
the beginning and thus produces sleep, without an initial stage of 
excitement. 

SCOPOLAMINE or hyoscine, acts very much like atropine, ex- 
cept that it is still more depressant to the cerebrum than hyos- 
cyamine. Its narcotic effects are so marked that it has been used 
as a general anaesthetic. 

HOMATROPINE has the same general action as atropine, but 
less intense. It dilates the pupil and relaxes accommodation 
more quickly than atropine, yet the paralysis of adaptation and 
accommodation is of shorter duration. 

SUMMARY OF THE GROUP ACTION.— Paralysis of the 
nerve endings of secretory glands, smooth muscle fibres and inhibitory 
apparatuses with decrease in the secretion of the skin, respiratory 
and gastro-intestinal tract, with relaxation of the smooth muscles 
in the gastro-intestinal and urinary tracts, also with relaxation 
of the iris and ciliary muscles giving rise to paralysis of accom- 
modation and adaptation but increase in the intraocular tension. 
Quickening of the pulse due to paralysis of the vagus endings. 
The respiratory and vasomotor centres in the medulla first stimu- 



70 CONSTITUTIONAL ORGANIC DRUGS. 

lated then depressed. The brain usually first stimulated, giving 
rise to delusional symptoms, then depressed with resulting narcosis. 

THERAPEUTIC APPLICATION.— Atropine is used in small 
doses to increase the functional activity of the medulla in cases of 
collapse, or of poisoning, where either or both the respiratory and 
vasomotor centres are depressed. It is considered a good anti- 
dote for morphine on the centre of respiration. 

On account of its action on secretory nerves, it is used to 
decrease sweating in phthisis or obesity, to decrease excessive 
secretions of the bronchi in bronchorrhcea, before etherization to 
lessen salivation, and to stop the secretion of milk. 

It is used on account of its paralyzing action on the vagus in 
cases of low pulse rate due to intracranial tumors or tumors of the 
neck pressing on this nerve. It is also used to paralyze the vagus 
terminations in the lungs in order to relieve spasmodic contraction 
of the bronchiole, as is supposed to occur in asthmatic attacks. 

It is useful in spasmodic constipation, as that due to lead 
poisoning. In such cases it acts by depressing the motor nerve 
endings of the smooth muscles and even the muscle fibres them- 
selves, thus relieving the spasm. 

It is used to relieve spasmodic contraction of other organs, 
such as that of the ureter, bladder, gall bladder, bile ducts and 
urethra, in cases of stones or other conditions in these organs pro- 
ducing spasm. On account of both its depressing effect on the 
secretion of hydrochloric acid and its paralyzing effect upon the 
pyloric sphincter, atropine has been used with much success, both 
internally and by subcutaneous injection, in diseases of the stom- 
ach attended with hyperacidity and pylorospasm, as ulcers and 
erosions. 

Atropine finds a great field of usefulness in ophthalmology, 
where it is employed to dilate the pupil and to paralyze accom- 
modation in order to permit of examination of the eye. The di- 
latation is also used to prevent anterior adhesions or to break 
them up when they exist. It is contraindicated where there is an 
increase of intraocular tension, as in glaucoma. It should only 
be used in small quantities in the eye, as systemic poisoning may 



GROUP OF ATROPINE. 7 1 

occur from absorption. Well-marked local irritation of the eye, 
which is of no serious import, may be seen after the application 
of atropine to this organ. 

Atropine preparations are sometimes employed as a local 
anodyne over neuralgic nerves or rheumatic joints. 

Hyoscyamine and Scopolamine are both used as narcotics 
in cases of nervousness, delirium tremens, mania, and other 
conditions attended with an increase in the functional activity 
of the cerebrum. Scopolamine is especially valuable for these 
conditions and has also been used as a general anaesthetic in 
combination with morphine. 

Homatropine is used exclusively in the eye to dilate the pupil 
and relax accommodation during examinations. It is preferable 
to atropine for this purpose because the dilatation is more rapid 
and less lasting. Sometimes accommodation is not completely 
paralyzed by homatropine. 

MATERIA MEDICA. 

Belladonna Folia and Belladonnae Radix (U.S.P.,B.P.), leaves and 
roots of Atropa Belladonna or Deadly Nightshade, a bushy shrub growing in 
Europe and America. The leaves contain 0.35 G. while the roots contain 
0.5 G. of total alkaloids. Among these are atropine, belladonnine, hyos- 
cyamine, scopolamine, atroscine and atropamine. Atropine is present in 
largest quantities. 

Tinctura Belladonnae Foliorum (U.S.P.). Tinctura Belladonna 
(B.P.). Dose: — 0.3-2.0. Br. (5-3015/). Average (U.S. P.) 0.5 c.c. 

Emplastrum Belladonnae (U.S.P.,B.P.). 

Unguentum Belladonnae (U.S.P.,B.P.). 

Extractum Belladonnae Foliorum (U.S.P.). Extractum Belladonnas 
Alcoholicum (B.P.). Dose: — 0.005-0.05. Br. (to-i grain). Average 
(U.S.P.) 0.01 G. 

Fluidextractum Belladonnae Radicis (U.S.P.). Dose: — 0.05-0.2. 
Average (U.S.P.) 0.05 c.c. 

Hyoscyamus (U.S.P.) or Hyoscyami Folia (B.P.), leaves and flowering 
tops of Hyoscyamus Niger or Henbane. It contains the alkaloids, scopol- 
amine, hyoscyamine and atropine. The total alkaloids amount to 0.08%. 
The latter is present in smaller quantities than the other two. 

Tinctura Hyoscyami (U.S.P.,B.P.). Dose:— 0.5-5.0 c.c. Br. iy 2 B). 
Average (U.S.P.) 2.0 c.c. 

Fluidextractum Hyoscyami (U.S.P.). Dose: — 0.3-1.0. Br. (5-15 
ttji). Average (U.S.P.) 0.2 c.c. 

Stramonii Semen and Stramonii Folia (U.S.P. ,B.P.), seeds and 
leaves of Datura Stramonium or Jimpson Weed. These contain the alkaloid, 
hyoscyamine, atropine with smaller quantities of scopolamine. 



72 CONSTITUTIONAL ORGANIC DRUGS. 

FluidextractumStramonii(U.S.P.). Dose: — 0.05-2.0. Average (U.S.P.) 
0.05 c.c. 

Tinctura Stramonii (U.S.P.,B.P.). Dose:— 0.5-1.5. Br. (17-20 tir). 
Average (U.S.P.) .0 c.c. 

Other plants containing the members of the atropine series are Duboisia 
Myoporoides, Scopolia Atropoides and Atropa Mondragora. 

Atropina (U.S.P.,B.P.), white, crystalline alkaloid with a bitter taste, 
soluble in 3 parts alcohol, almost insoluble in water. It is an ester 
formed by the union of the base tropine and tropic acid. Dose : — 0.0005- 
0.001. Br. (zhrrhs grain). Average (U.S.P.) 0.0004 G. 

Atropinae Sulphas (U.S.P.,B.P.), white, crystalline, soluble in H 2 and 
alcohol. In the eye 1 per cent, solution. Dose:- — 0.0005-0.001. Br. 
(?<hr-T<io grain). Average (U.S.P.) 0.0004 C. 

Hyoscyamina, isomer of atropine. It has almost the same properties. 
Dose : — 0.0005-0.001. 

Hyoscyaminae Sulphas (U.S.P.,B.P.), white crystalline deliquescent 
body, soluble in H 2 and alcohol. Dose: — 0.0005-0.001. Br. (zhrrhr 
grain). Average (U.S.P.) 0.0005 G. 

Hyoscyaminae Hydrobromidum (U.S.P.,B.P.), same properties as the 
sulphate, but not deliquescent. Dose same as above. 

Hyoscinse Hydrobromidum (U.S.P., B. P.), colorless crystals soluble in 
H 2 and alcohol, slightly efflorescent. Dose: — 0.0003-0.0005. Br. 
Grforrfo grain). Average (U.S.P.) 0.0005 G. 

Scopolamine Hydrobromidum (U.S.P.). Dose: — Average (U.S.P.) 
0.0005. 

Homatropinae Hydrobromidum (U.S.P.,B.P.), an artificial alkaloid, 
being an ester of tropine and phenylglycolic acid, soluble in 6 parts of H 2 0, 
used in the eye in 1 per cent, solution. 



GROUP OF AGARIC ACID. 

AGARIC ACID in the form of its crude preparation, the fungus, 
white agaric, has been used for two centuries in Europe to de- 
crease the excessive secretion of sweat. 

Like atropine, it paralyzes the nerve endings of the sweat 
glands, causing dryness of the skin. It does not paralyze 
the nerve terminations of the salivary glands, nor those of the 
gastro-intestinal tract, nor does it paralyze the nerve endings of 
organs with smooth muscle fibres, nor the inhibitory apparatus 
of the vagus. 

It is a very powerful local irritant which may produce abscess 
by subcutaneous injection, nausea, vomiting and diarrhoea after 
internal administration, and sneezing after snuffing. Although 
the local irritation may be very severe after ingestion, this mode 
of application never produces fatal results. The crude drug, or 



GROUP OF MUSCARINE AND PILOCARPINE. 73 

impure Agaricin, which contains very irritant resinous acids, 
cause much more irritation than the pure agaric acid. 

When injected subcutaneously as a sodium salt in the dose of 
0.0 1 G. into a small cat, the acid arrests the secretion of sweat 
on the plantar side of the paw within four to six hours and elec- 
trical stimulation of its sciatic nerve does not produce sweat- 
ing. With larger doses, it produces at first a stimulation of the 
respiratory, vasomotor and vagus centres in the medulla, with 
a consequent increase in respiration and blood pressure and a 
slowing of the pulse. With still larger doses, paralysis, failure of 
respiration, circulation, and quickening in the rate of the pulse 
occur. In frogs, large doses paralyze the heart directly. 

SUMMARY OF THE GROUP ACTION.— Decrease in the se- 
cretion of sweat by paralysis of the nerve endings of the sudoriferous 
glands. At first stimulation of the respiratory and vasomotor 
centres in the medulla, followed by depression. Severe local irritant 
action leading to inflammation of the skin, vomiting and diarrhoea. 

THERAPEUTIC APPLICATION.— It is used almost exclu- 
sively as an antihydrotic to arrest the night sweats of phthisis. It 
requires about 0.02 to 0.03 G. to produce this effect. It may 
cause nausea in larger doses. 

MATERIA MEDICA. 

Agaricinum, obtained from the fungus Boletus Laricis, growing on 
European larch trees; it is a white powder, soluble with great difficulty in 
water and contains Agaric Acid with impurities, and is about one-twentieth 
as strong as the latter. Dose : — 0.01-0.06 G. 

Acidum Agaricum, white powder, a pure preparation obtained from 
the above, soluble with difficulty in water, but dissolves easily in the presence 
of alkalies with the formation of salts. Dose : — 0.0005-0.003 G. 

GROUP OF MUSCARINE AND PILOCARPINE. 

This group comprises Muscarine, the poisonous principle of 
toadstools or fly-mushrooms ; the two alkaloids, Pilocarpine and 
Pilocarpidine present in Jaborandi leaves; and Nicotine obtained 
from tobacco. The characteristic action of these alkaloids is 
diametrically opposite to that of atropine. They stimulate all 
the peripheral organs which are depressed by atropine, such as 



74 CONSTITUTIONAL ORGANIC DRUGS 

the secretory glands, smooth muscle fibres and inhibitory ap- 
paratuses. 

MUSCARINE by stimulating the inhibitory vagus in the heart, 
slows and even stops the latter in diastole. By increasing the func- 
tion of secretory nerve endings, it brings forth an increase in 
the secretion of the salivary, laryngeal, sweat, gastric, intestinal 
and pancreatic glands. By stimulation of the nerves of the 
smooth muscles of the stomach and intestines, it produces con- 
traction of these organs with vomiting and diarrhoea. On ac- 
count of its effect on the nerves of the smooth muscles of the 
bladder, it causes a contraction of the latter and urination. The 
stimulant action on the endings of the nerves supplying the 
muscles of adaptation and accommodation, produces a contraction 
of the pupil and a spasm of accommodation. Even the muscles of 
the spleen, bronchi and uterus are contracted by muscarine, 
with consequent contraction of these organs. This alkaloid pro- 
duces in cold-blooded animals, paralysis of the motor end plates 
of nerves of the skeletal muscles. This depressant action on 
motor nerve plates is more striking after the administration of 
artificial muscarine and various ammonium bases which have the 
general characteristics of the group. 

In contrast with its stimulant action on the peripheral ner- 
vous system, muscarine exerts chiefly a depressant influence 
upon the central nervous system. After a preliminary stimu- 
lation of the respiratory centre, causing an increase in the rate 
and depth of respiration, it produces a depression which results 
in a decrease of the respirations followed by a total arrest. The 
vasomotor centre is also depressed, therefore the blood pressure is 
lowered. The other parts of the central nervous system are not 
so markedly affected. 

In cases of poisoning in human beings, the first symptoms 
resulting from stimulation of the peripheral organs are salivation, 
sweating, nausea, vomiting, cramps and diarrhoea, contracted 
pupils. Usually at first there is increase in pulse rate from the 
nausea, followed by a decrease in its rate, due to a stimulation of 
the vagus nerve. Symptoms of central depression and collapse 



GROUP OF MUSCARINE AND PILOCARPINE. 75 

follow closely the appearance of those of peripheral stimulation, 
and'consist of dizziness, oppression, stupor and loss of conscious- 
ness. Death takes place from arrest of the heart. 

Although the pupils are always contracted by pure muscarine, 
they are often dilated in poisoning by fly-mushrooms containing 
Muscaridine which acts like atropine. 

PILOCARPINE resembles muscarine very closely in its action, 
but is much less powerful. The stimulant action on the per- 
ipheral organs and especially on those of sweat and salivation, 
forms the striking feature of the action of pilocarpine. With 
small doses in man, profuse sweating often accompanied by sali- 
vation are practically the only symptoms observed. With larger 
doses, contraction of the smooth muscles of the stomach and 
intestines, with nausea, vomiting and diarrhoea occurs. The 
central nervous system is affected later, and only with much 
larger doses than muscarine. It also differs from muscarine, 
by paralyzing the inhibitory apparatus of the vagus after the 
primary stimulation; thus it increases the pulse rate after a pri- 
mary decrease. Later it paralyzes the heart itself. Pilocarpine 
also partly dilates the pupils after first contracting them, by a 
paralysis of the oculomotor nerve in the iris, following its stimu- 
lation. If it were not for the contraction of the pupils, the intra- 
ocular pressure would be raised by pilocarpine, therefore, it is only 
lowered when they are well contracted. 

PILOCARPIDINE acts like pilocarpine, but less powerfully. 

NICOTINE has much the same action as pilocarpine, but it de- 
presses much more the central nervous system, and especially 
the respiratory centre. It causes clonic convulsions and fibrillary 
twitchings of different muscles which are due partly to primary 
stimulation of the central nervous system and of the motor nerve 
endings, and partly to the asphyxia caused by paralysis of the 
respirations. 

As a result of this primary effect on the central nervous system, 
the respiration is increased and the blood pressure is raised. 
These evidences of stimulation soon subside when the blood 
pressure falls and death takes place from respiratory paralysis. 



76 CONSTITUTIONAL ORGANIC DRUGS. 

Nicotine stimulates at first the inhibitory, secretory and motor. 
peripheral nervous apparatus. This is succeeded by 
a paralysis of these organs, so that the slowing of the heart, 
due to stimulation of the vagus, is soon replaced by quicken- 
ing, due to paralysis of this nerve. The increased salivation, 
lachrymation and sweating are followed by a diminution of these 
secretions; the spasmodic contraction of the smooth muscles of 
the intestines is followed by relaxation. The pupil is at first con- 
tracted, but later partly dilated. The seat of action is not, as 
with muscarine and pilocarpine, the nerve endings, but is the 
ganglia between the nerves and the organs. 

At first, nicotine stimulates the cardiac muscles, and this is in 
part the cause of the quickening of the pulse; this stimulation is 
soon followed by a depression and the pulse becomes weak with 
the paralysis of the heart muscle. 

The increased blood pressure observed at the beginning of the 
action of nicotine is due, not only to the stimulation of the heart 
muscle, but also to a stimulant action on the vasomotor centre 
in the medulla and on the ganglia in the walls of the blood vessels. 

In frogs, nicotine at first stimulates motor nerve endings 
and causes twitching, but later paralyzes them, as does curare. 

When tobacco is first used by persons unaccustomed to its 
effect, a condition of acute poisoning of greater or lesser intensity 
occurs. In the milder cases there are only dizziness, quickened 
pulse, nausea, vomiting and diarrhoea. In severer types, con- 
vulsions, unconsciousness and even collapse may be observed 
after the first smoke. 

Prolonged use of nicotine in the form of smoke, chew or 
snuff brings about a condition of tolerance so that much more can 
be taken without apparent disagreeable symptoms, and the habit- 
ual smoker can smoke with impunity quantities of tobacco 
which might produce collapse in a novice. Chronic use of to- 
bacco is not without danger, for it is apt to produce irritation of 
the upper respiratory passages and of the stomach. These 
consist of chronic pharyngitis, laryngitis and bronchitis, and often 
give rise to a very disagreeable dry cough, hoarseness and attacks 



GROUP OF MUSCARINE AND PILOCARPINE. 77 

of sore throat. The irritation in the mouth may produce dry- 
ness and a mild degree of inflammation of the tongue, which 
is said to predispose to cancer of this organ and also to epithe- 
lioma of the lips. Chronic dyspepsia, with loss of appetite and 
weight, is not infrequently seen in incessant smokers. Hyper- 
acidity of the stomach may be aggravated by the constant use of 
tobacco. 

Excessive smoking frequently causes quickening, weakness 
and irregularity of the heart (tobacco heart). The vision is 
often affected by interference with accommodation, also changes 
in the optic nerve and retina and temporary blindness may even 
occur (tobacco amblyopia). These changes in the eye usually 
disappear when smoking is discontinued. It is also possible 
that very excessive use of tobacco may be a factor in the causa- 
tion of arterio-sclerosis. 

SUMMARY OF GROUP ACTION.— Stimulation of all per- 
ipheral organs depressed by atropine, including secretory glands, 
smooth muscle fibres and inhibitory apparatuses. Increased sweat, 
salivation, bronchial and gastro-intestinal secretions. Contraction 
of smooth muscles of intestines, bladder, ureter, gall bladder, iris and 
ciliary body, the effect on the two latter causes contracted pupils, 
spasm of accommodation and decreased intraocular tension. In- 
creased action of the inhibitory vagus with decrease of pulse rate. 
Central nervous system first stimulated then paralyzed with death 
from failure of respiration and circulation. 

THERAPEUTIC APPLICATION.— Pilocarpine is the only 
member of this group which is used in practical therapeutics. 
The chief indications for its employment are dropsical conditions, 
especially those due to diseases of the kidneys. It acts by increas- 
ing the elimination of water through its stimulant action on the 
sweat glands. It also relieves the work of the diseased kidneys 
by increasing the vicarious functions of the skin. 

Pilocarpine should be used only with great caution in patients 
with cardiac weakness, because of its tendency to depress the 
heart. It is contraindicated in oedema of the lungs, because by 
stimulating the bronchial secretion it may increase the exudation 



78 CONSTITUTIONAL ORGANIC DRUGS. 

in these organs. Its power of increasing the bronchial secretions 
makes it a useful expectorant in the first stages of colds or influenza 
when the mucous membranes of the bronchi are dry and con- 
gested. 

Pilocarpine is used in ophthalmic practice to contract the 
pupil in cases of posterior adhesions of the iris to the lens, and to 
break up such adhesions. It is employed in glaucoma to decrease 
intraocular tension. For this indication it is inferior to phy- 
sostigmine because the intraocular pressure is first raised before 
it is decreased. 

On account of the stimulant action on glandular secretions, 
it is applied as a hair tonic to prevent the fall of hair, when this is 
due to a dry anaemic condition of the scalp. 

Otologists use pilocarpine in different diseases of the labyrinth 
and middle ear, and it may improve dry catarrh of the latter by 
stimulating its glands. 

Nicotine has been injected in the form of clysters, consisting of 
infusions of tobacco leaves. Occasionally the smoking of a cigar 
or a few cigarettes may be sufficient to move the bowels in mild 
constipation. 

Muscarine is only of toxicological interest, but the methods 
of treating cases of poisoning from this alkaloid are of great im- 
portance to the practitioner. Such cases occur after the acci- 
dental ingestion of toad-stools instead of edible mushrooms. 
The basis of the treatment consists of the administration of the 
almost exact antidote, atropine, until the symptoms improve, in 
washing out the stomach, and administering a purge to remove 
the remaining mushrooms. 

MATERIA MEDICA. 

Muscarine is a strongly alkaline deliquescent alkaloid, very soluble in 
water, found in the fly mushrooms, Agaricus muscarius. It is related 
chemically to choline. Choline is also present in these mushrooms, besides a 
volatile substance which kills flies, and muscaridine, an alkaloid, which 
resembles atropine. 

Pilocarpus (U.S. P.), Jaborandi Folia (B.P.) are the leaflets of Pilocarpus 
Jaborandi, a shrub growing in South America which contains }4 per cent, 
of the alkaloids pilocarpine and pilocarpidine, both of very similar chemical 
structure. There also occurs as a decomposition product of the former, 



GROUP OF PHYSOSTIGMINE. 79 

the alkaloid jaborine which, however, has an action similar to atropine 
and, therefore, does not belong to this group. 

Pilocarpina is an amorphous or oily alkaloid, very soluble in water and 
alcohol. It forms stable salts with acids. 

Pilocarpine Hydrochloridum (U.S.P.), white crystals, soluble in water 
and alcohol. It is the most commonly used preparation of pilocarpine and 
is often administered subcutaneously. Dose: — 0.01-0.02 G. Average 
(U.S.P.) 0.01 G. 

Pilocarpine Nitras (U.S. P., B .P.), properties much like the hydro- 
chloride. Dose: — 0.01-0.02 G. Br. (2V1 grain). Average (U.S.P.) 0.01 G. 

Nicotina is a volatile colorless liquid alkaloid found in the leaves of Nico- 
tiana Tabacum or common tobacco. 

Duboisia Hopwoodii yields the alkaloid piturine, while Nigella Sativa 
yields nigelline, both of these having a pharmacological action similar to 
nicotine. 



GROUP OF PHYSOSTIGMINE. 

Physostigmine (Eserine), and Eseridine, two alkaloids ex- 
tracted from the calabar bean, produce symptoms resembling, to 
some extent, those occasioned by muscarine. They are more 
conveniently described in a separate group, because the seat of 
action is on the muscular and glandular protoplasm instead of on 
nerve endings, as with muscarine, and because they have a special 
action also upon the cardiac and striated muscles. 

PHYSOSTIGMINE stimulates the protoplasm of all muscles, 
striated, unstriated and cardiac. From the stimulation of 
striated muscle fibres, we observe fibrillary contraction of all 
skeletal muscles which may even last for a considerable time after 
the death of an animal poisoned by physostigmine. From the 
stimulation of the smooth muscle fibres there occur vomiting, 
defecation, urination, and contraction of the ureter, spleen, 
bladder, uterus and pupil. From the stimulation of the heart 
muscle, we see a great increase in the force and completeness of 
contraction of this organ, as a consequence of which it always 
beats for a considerable time after respiration has stopped. The 
rate of the pulse is also decreased by direct action on the heart 
muscle, and in cases of poisoning, patients have complained of 
a tumultuous cardiac action. Stimulation of the protoplasm of 
the salivary, lachrymal and sweat glands produces an increase 
in their secretions. 



80 CONSTITUTIONAL ORGANIC DRUGS. 

The central nervous system, after a very brief stage of pri- 
mary stimulation, is powerfully depressed, especially the centres 
in the medulla. The respirations are at first increased in 
depth and frequency, then, as the centre becomes paralyzed, 
they become superficial and dyspnceic. The blood pressure at 
first rises on account of a combination of circumstances as follows : 
firstly, the tremendous stimulation and increase in the strength 
of the cardiac muscles, secondly, the squeezing out of the blood 
from the vessels of the splanchnic area due to the cord-like con- 
traction of the intestines, and lastly, the primary stimulation of 
the Vasomotor centre. The latter, however, can be of but little 
importance because the depression of this centre quickly succeeds 
the initial stimulation. Although the blood pressure falls at 
last, the imminent cause of death is the paralysis of respiration. 

The cord is also depressed and this causes the weakness and 
even paralysis of the limbs which is seen during poisoning by 
physostigmine. The brain is affected very late for consciousness 
remains almost until the end. The anxiety and restlessness 
usually observed is due to interference with respiration and not 
to stimulation of the brain and cord. 

The pupil is contracted by direct stimulation of the iris muscle, 
but the contraction is not so complete as with muscarine because 
both sets of fibres are affected so that the weaker radial antagonize 
to a certain extent the action of the circular fibres. The ciliary 
muscle is also stimulated so that the lens is focused for near ob- 
jects. By local application, contraction of the pupils appears 
within one hour and lasts from eight to twenty-four hours or 
more. The intraocular pressure is decreased partly in conse- 
quence of the narrowing of the pupil but chiefly by contraction of 
the vessels of the eyeball. 

Physostigmine is excreted rather rapidly and mainly in the 
urine, although it has been found in traces in the bile and saliva. 

The symptoms of poisoning consist of giddiness, anxiety, 
dyspnoea, excitement, palpitation of the heart, severe pain in the 
region of the stomach, nausea, vomiting and diarrhoea, salivation, 
perspiration, and contraction of the pupils, great weakness of the 



GROUP OF PHYSOSTIGMINE. 8 1 

limbs, and even inability to stand, accompanied by tremors, 
general muscular twitchings, and at last convulsions, unconscious- 
ness and death from stoppage of respiration. Sometimes no 
vomiting occurs if the absorption is very rapid, and in such 
cases unconsciousness and paralysis of respiration come quickly. 

The crude calabar bean, the source of physostigmine, is used 
by the natives of certain tribes of Africa as an ordeal, to try 
the criminality of accused subjects. The crucial test consists 
of whether or not the suspect dies after the ingestion of a certain 
number of the beans, but that really depends on whether or not 
he vomits. If the drug is expelled quickly by vomiting he may 
not have absorbed enough to paralyze the, central nervous system, 
while if he retains it a long time fatal results occur. 

SUMMARY OF THE GROUP ACTION.— Stimulation of 
striated, cardiac and smooth muscle fibres and of the secretory glands. 
Resulting twitching of skeletal muscles, tremendous increase in the 
force of the heart beat, and spasmodic contraction of the smooth 
muscles of the intestines, bladder, gall bladder, ureter, spleen, etc., 
also increase in the secretion of the salivary, bronchial, sweat and 
gastro-intestinal glands. Primary stimulation of the centres in the 
medulla quickly followed by intense depression, producing death by 
failure of respiration. 

THERAPEUTIC APPLICATION.— Physostigmine has been 
used in the past in various diseases of the nervous system, but 
without much success. Unfortunately, its stimulant action upon 
the heart and skeletal muscles cannot be utilized because of its 
great depressant effect upon the medulla. Formerly it was 
recommended to relieve atony of the bowels. In constipation 
from this cause, physostigmine, in small doses, was said to be 
beneficial, but actual experiments on human beings have failed 
to support this use. 

When applied locally to the eye, it may assist in breaking up 
adhesions of the iris, but its chief use is to reduce the intraoc- 
ular pressure in glaucoma. 



82 CONSTITUTIONAL ORGANIC DRUGS. 

MATERIA MEDICA. 

Physostigma (U.S.P.), Physostigmatis Semina (B.P.), or Calabar or 
Ordeal Bean, consists of the seeds of Physostigma Venenosa, a woody 
climber growing in Africa which contains 0.15 per cent, of the alkaloid phy- 
sostigmine including small quantities of eseridine, an alkaloid having a close 
resemblance in composition and action, and also traces of the alkaloid cala- 
barine which has an action resembling strychnine. 

Physostigmina, colorless crystals, insoluble in water, slightly soluble 
in alcohol. 

Physostigminae Salicylas (U.S. P.), slightly yellow crystals which easily 
turn brown, difficultly soluble in water, but soluble in alcohol. 

Physostigminae Sulphas (U.S.P.,B.P.), white, deliquescent crystals, 
soluble in water and alcohol. Dose: — for physostigmine and its salts 
0.0005-0.001. Br. (ifo-^o grain) not more than 0.003 m 2 4 hours. Average 
(U.S. P.), 0.001 G. In the eye use 1 to 3 drops of % per cent, to 1 per cent, 
solution. k 

GROUP OF COCAINE. 

The leaves of Erythroxylon Coca, a tree growing in Bolivia 
and Peru, have been used for a long time by the Indians of these 
countries to relieve hunger and to enable them to make long, 
fatiguing marches without exhaustion. It is probable that the 
increased power for muscular exertion which they experienced 
was due to a stimulation of the central nervous and muscular 
systems akin to that produced by caffeine. The diminution 
in the sensation of hunger resulted from a local anaesthetic action 
on the endings of the sensory nerves in the stomach. 

Paralysis of the endings of sensory nerves is one of the main 
features in the action of COCAINE. It only takes place when so- 
lutions are applied locally on a mucous membrane, on abrased 
surface or underneath the skin. The sensation of pain and touch 
is more decreased than that of heat. After topical application of 
a 4 per cent, solution, local anaesthesia occurs in about five to ten 
minutes and lasts about twenty minutes. 

Local applications to nerve trunks and even to the spinal cord 
are followed by sensory paralysis. When a solution of cocaine 
is painted on a nerve, all the area to which sensation is supplied 
is rendered anaesthetic. When it is injected in small quantities in 
the lumbar region of the spinal canal, sensory paralysis of the 
legs and trunk occurs which may permit of painless amputation 






GROUP OF COCAINE. 83 

of a leg or of laparotomy. By this mode of application the 
paralysis is chiefly of sensation of pain, for the sense of touch, 
heat and cold and motor function may remain unchanged. 

When sufficient cocaine has reached the circulation, the central 
nervous system is at first stimulated, but later depressed, and 
death takes place mainly through failure of respiration. Under 
these circumstances no paralysis of the peripheral sensory nerve 
endings occurs in warm-blooded animals, because death takes 
place from a much smaller quantity than would be necessary to 
produce this effect. At first, on account of the stimulation of the 
central nervous system, cocaine produces nervousness, restless- 
ness, headache, nausea and vomiting, rise of blood pressure 
and temperature, hurried respirations, delirium and even clonic 
convulsions. Subsequently, or at times from the beginning, the 
following symptoms of central paralysis occur: great weakness, 
coldness of the extremities, dulness of the intellect, decreased 
respiration, fall of blood pressure, cyanosis and death. 

The increase in respiration is due to stimulation of the res- 
piratory centre. The latter, however, is soon depressed and 
death is mainly caused by its paralysis. The primary increase in 
blood pressure results from stimulation of the vasomotor centre, 
and from increased rate of the heart. The quickening of the 
pulse is probably caused by a stimulant action on the accelerator 
nerves. The fall of blood pressure and failure of circulation 
which soon ensue are due to direct paralysis of the heart and of 
the vasomotor centres. 

The local application of cocaine causes a powerful contraction 
of the blood vessels, which produces in the nose a shrinking of 
the turbinates, in the throat and other mucous membranes a 
blanching and dryness of the mucosa, and in the eye a decrease 
in the intraocular tension. The pupils are dilated, probably 
by stimulation of the dilator fibres. 

When cocaine is used in the eye, the cornea occasionally be- 
comes clouded on account of necrosis of the epithelium. Be- 
cause of its destructive action on protoplasm, abscesses may 
form after subcutaneous administration of cocaine. In mice, 



84 CONSTITUTIONAL ORGANIC DRUGS. 

necrosis and vacuolation of liver cells may take place after in- 
ternal administration. These effects are probably due to general 
protoplasmic poisonous action of cocaine, because it also stops 
the movements of leucocytes, spermatozoa and certain vegetable 
cells, as does quinine. 

The body temperature is raised, perhaps by some action on 
the heat-regulating mechanism. 

When cocaine is taken over a period of time, a habit is formed 
as with morphine, and a craving for the drug is developed. The 
symptoms of chronic cocaine poisoning resemble closely those 
of chronic morphinism and consist of gastro-intestinal disturb- 
ances, anorexia, loss of weight and strength, tremors, sleeplessness, 
hallucinations, delirium, and sometimes convulsions. 

Cocaine is almost completely oxidized in the body of most 
animals, and the small amounts which escape oxidation, are 
found in the urine. 

In attempting to make substitutes for cocaine it was dis- 
covered that esters of benzoic acid especially had local anaes- 
thetic properties. Prominent among these are Beta-Eucain, 
Stovain, Novocain, Alypin, Orthoform, Anaesthesin and Sub- 
cutin. All these bodies are weaker local anaesthetics than cocaine. 
The strongest are stovain and subcutin. Besides, may be included 
as substitutes of cocaine, Tropacocain, an alkaloid obtained 
from Javanese coca leaves, said to have a very similar action, also 
Holocain, a derivative of phenacetin which is very poisonous, 
and lastly, Yohimbin, an alkaloid obtained from the African 
Yohimbe tree. The latter is also used internally to increase 
sexual power in impotence in the male. 

SUMMARY OF GROUP ACTION.—^ local application, 
paralysis of sensory nerve endings, nerve trunks and posterior spinal 
roots, producing sensory paralysis of the parts supplied and especially 
depression of the sense of pain. Primary stimulation of the central 
nervous system with excitement, delusions, convulsions, increased 
respiration and rise of blood pressure, followed by paralysis with 
cold extremities, weak pulse and respiration and death in coma. 



GROUP OF COCAINE. 85 

THERAPEUTIC APPLICATION.— Cocaine was formerly 
used in small doses on account of its primary stimulant action on 
the central nervous system. This use is now practically discon- 
tinued on account of the danger of forming a habit and of pro- 
ducing collapse in very susceptible subjects. 

The main application of cocaine is as a local anesthetic to quiet 
pain and to allow painless operations. It is used in the eye to 
quiet the pain horn foreign bodies, to remove cataracts, to perform 
iridectomy, enucleation, etc. It is also employed for practically 
all nasal and laryngeal operations and has the advantage in the 
nose of shrinking up the turbinated bodies, thus allowing a better 
field of operation. It is used subcutaneously for minor opera- 
tions and also for major operations, as laparotomy. When applied 
for major surgical operations it is usually given by Schleictis in- 
filtration method. This consists of infiltrating a large bulk of a 
very dilute solution of cocaine between the layers of the skin. 
The local anaesthetic action is brought about partly by the specific 
effect of cocaine and partly by the pressure of the fluid on the 
sensory nerve endings. 

Another method of using cocaine and some of its allies, as 
stovain, novocain, etc., for major operations, is by intraspinal 
injections. This consists of injecting 0.01 to 0.02 G. by lumbar 
puncture. Adrenaline is now usually injected with the local 
anaesthetics, as it increases their action and decreases their poison- 
ous symptoms. In about half an hour the lower limbs and abdo- 
men become completely narcotized so that amputations and 
laparotomies can be performed without pain. There are, how- 
ever, two great objections which make this method impracticable, 
first, the greater shock on account of the consciousness of the 
patient, and second, the poisonous symptoms consisting of delir- 
ium, nausea, vomiting, headache and collapse which often follow 
when cocaine is applied in this way. Another very alarming 
symptom which occasionally occurs, is the motor paralysis of the 
limbs which may last from a few days or weeks to permanency. 
In explanation of this fact there have been found severe histolog- 
ical changes in the spinal cord of animals and also in those of 



86 CONSTITUTIONAL ORGANIC DRUGS. 

human beings, who died after intraspinal anaesthesia with cocaine, 
stovain or novocain. 

MATERIA MEDICA. 

Coca (U.S. P.), dried leaves of Erythroxylon Coca, a shrub growing in 
Bolivia, Peru and India. It contains a number of alkaloids, the chief one 
of which is cocaine. 

Fluid extractum Cocae. Dose: — 2.0-4.0 c.c. 

Cocaina (B.P.), white, crystalline alkaloid, insoluble in H 2 0, soluble 
in alcohol. It can be broken up into ecgonine, benzoic acid and methyl- 
alcohol. 

Cocainae Hydrochloridum (U.S. P., B. P.), colorless crystals, bitter and 
benumbing taste, soluble in H 2 and in alcohol. It is decomposed by 
boiling water. Used locally in % to yi per cent, solution to quiet pain, in 3 
to 6 per cent, solution to allow of surgical operation or examination by in- 
struments. The use of 10 to 20 per cent, solution is often attended by 
poisonous symptoms. Poisoning frequently results from local application in 
the urethra and bladder. It should not be used over a period of time for 
fear of producing habit. By Bier's intraspinal or by Schleich's infiltration 
methods, not more than 0.02 G. should be used. Dose: — 0.005-0.05 G. 
Br. Q-i grain), per day, up to 0.15 G. Average (U.S. P.) 0.03 G. 

Alpha- and Beta-Eucaine are local anaesthetics less poisonous than co- 
caine, but very irritant. They do not dilate the pupil, nor constrict per- 
ipheral vessels. Used in 2 to 4 per cent, solutions. 

Holocaine is more poisonous than cocaine, and has no action on pupil 
and vessels. Used as a local anaesthetic in yi to 1 per cent, solution. 

Stovain, white crystals soluble in water and alcohol. For local anaes- 
thetic action subcutaneously, use 0.5-1 per cent, solution, and effect comes 
in from one to four minutes and lasts twenty minutes; for mucous mem- 
branes of the nose and throat, use 5 per cent, solutions, and for spinal anaes- 
thesia inject 0.05 G. into the medullary canal. 

Novocainum, white crystals soluble in water; used in from x /i-2 per 
cent, solution. 

Alypin, white crystals also soluble in water; used in 2 per cent, solution. 

Orthoformium Novum, benzoic acid derivative, which is almost insolu- 
ble in water. It is not absorbed easily and does not produce poisonous 
symptoms, but its local anaesthetic action is very weak and superficial. 
Used as a 10 per cent, to 20 per cent, ointment or powder over painful 
ulcers, also internally in ulcers or cancers of the stomach in the form of a 
powder. Dose: — 0.5-1.0 G. 

Anaesthesin is another insoluble local anaesthetic with properties very 
closely resembling those of Orthoformium. Used both locally and inter- 
nally. Dose: — 0.3-0.5 G. 

GROUP OF CURARE. 

In curare, an arrow poison, which the Indians of South Amer- 
ica prepare from various species of strychnos, there is present 
the alkaloid curarine and a number of closely related bodies. 



GROUP OF CURARE. 87 

All these substances have practically the same main action which 
consists of a paralysis of the motor end plates of neroes supplying 
striated muscles before any other organ is affected. 

When CURARINE is injected into animals, they lose the power 
of muscular contraction and after attempts at walking fall, in a 
limp condition, to the ground. They are still able to make a num- 
ber of jerky contractions of the extremities while their respirations 
become fewer and fewer. The power of muscular movement 
soon disappears completely, first from the muscles of the limbs, 
and lastly from those of respiration. Warm-blooded animals 
die when the respiratory muscles are paralyzed. After 0.00005 
G. a frog may remain motionless for days, and finally recover 
when the poison has been excreted. 

In man we have practically the same general symptoms as in 
animals, accompanied in the beginning by a feeling of fulness in 
the head with headache, by an increased secretion of sweat, tears, 
urine, and later by a blueness of the skin when the muscles of 
respiration have been paralyzed. 

With small doses, in all animals, the circulation and ner- 
vous system remain practically unaffected. When large doses 
are administered, and artificial respiration is maintained, cura- 
rine paralyzes the nerve terminations around the ganglia supply- 
ing the blood vessels, the inhibitory apparatuses of the heart and 
of the intestines. The blood pressure falls on account of the 
dilatation of the vessels, incident to paralysis of their ganglia. 
The increased flow of blood to glands resulting from this dilata- 
tion of the blood vessels may account for the augmented secre- 
tion of urine, sweat and tears. With large doses, there is an 
increase in the rate of the heart beat and a greater peristalsis 
of the intestines, because of the paralysis of the inhibitory ganglia 
of these organs. In very large doses curare paralyzes the central 
nervous system, although in frogs it, at first, causes an increase 
in the reflex irritability of the cord when applied directly to this 
organ with the circulation destroyed. It has no effect on the 
muscles as enormous doses do not change their irritability. 

Curare is absorbed very slowly from the stomach, so slowly 



SS CONSTITUTIONAL ORGANIC DRUGS. 

that no poisonous symptoms are seen from a dose given by the 
mouth, which is fatal when given subcutaneously or intravenously. 
The reason for this fact is that curarine is excreted more rapidly 
by the kidneys, than it is absorbed by the stomach so that a 
poisonous dose cannot have time to accumulate in the organism. 

Sugar and lactic acid may be found in the urine after poison- 
ing by curare. The presence of these abnormal products in this 
secretion and the destruction of glycogen in the muscles and liver, 
are probably due to asphyxia. The metabolism is greatly de- 
creased on account of the paralysis of the muscular system, and 
consequently the exchange of carbon dioxide may be much low- 
ered. 

Protocurarin is also found in the crude curare. It has the 
same qualitative, but a much stronger quantitative action, than 
curarine; besides there is also present Protocurin and Tubocura- 
rin, both with much weaker curare-like action than curarin. 
Curin on the other hand has almost the same effect as veratrine 
and does not belong to this group. 

SUMMARY OF THE GROUP ACTION.— Paralysis of motor 
nerve endings of all striated muscles causing death by paralysis of the 
diaphragm and other respiratory muscles. Large doses given while 
artificial respiration is maintained produce paralysis of the ganglia 
of blood vessels of the inhibitory apparatuses of the intestines and 
heart, with resulting fall of blood pressure, increased intestinal 
peristalsis and quickening of the rate of the heart. Absorbed 
very slowly by stomach but rapidly from subcutaneous tissues. 
Excreted rapidly by kidneys. 

THERAPEUTIC APPLICATION.— Curare was formerly used 
in conditions attended with convulsions such as tetanus, hydropho- 
bia and epilepsy. In tetanus and hydrophobia, it must be given 
in doses sufficient to depress the motor nerve endings of all the 
skeletal muscles, yet not large enough to paralyze those of respira- 
tion. Either the pure alkaloid or the crude drug which has 
been standardized on frogs, may be administered in the pres- 
ence of a medical attendant who should always be ready to per- 
form artificial respiration. The reports vary, but on the whole, 



ACONITINE SERIES. 89 

the results are not satisfactory enough to warrant this form of 
treatment except when all others have failed. 

MATERIA MEDICA. 

Curare, dark brown resinous mass, soluble in water, varying much in 
strength. Should be standardized on frog before using. The amount 
necessary to paralyze a 50 gram frog is equivalent to 0.00004 G. curarine. 

Curarinum Purissinum, brownish, yellow, amorphous body, soluble 
in water, alcohol, ether; does not form salts with acids. Dose: — 0.0005- 
0.003 G. subcutaneously. 



ACONITINE SERIES. 

The following series is composed of the groups of Aconitine, 
Coniine and Veratrine which have many properties in common. 
They have a very striking depressant action on the vital centres in 
the medulla which leads to death, but this depression is usually 
preceded by a more or less transient stimulation of the same. 
Their action on the nerve endings of peripheral organs, as those 
supplying sensory, motor and secretory apparatuses is usually 
first, a stimulation as with muscarine, then later a depression as 
with atropine. With most drugs of these groups a curare-like 
depression of the motor nerve endings of striated muscle fibres 
is a prominent symptom in cold-blooded animals, but with a 
few members as coniine and sparteine, this action becomes well 
marked in the warm-blooded. The various alkaloids of this 
series produce dilatation of the pupil. 

The picture of poisoning does not differ greatly in the different 
members. It consists of nausea, vomiting, diarrhoea, weakness, 
sweating and dryness of the skin, great dyspnoea and feebleness 
of the circulation with the sensorium remaining normal to the 
last. 

As might be expected, this series of groups is of but compara- 
tively small therapeutic value on account of the prominent depres- 
sion of the vital centres, and only occasionally a few members are 
used for some local or special internal purposes. 



9° CONSTITUTIONAL ORGANIC DRUGS. 

GROUP OF ACONITINE. 

ACONITINE produces, at first, a primary stimulation of the 
end apparatuses of the sensory, motor and secretory nerves which 
is followed by paralysis. If rubbed into the skin in alcoholic 
solution, it gives rise to a sensation of burning and prickling at 
the place of application which is followed by local anesthesia 
as with cocaine. When taken internally in sufficient doses, it 
causes at first a burning and scratching sensation in the throat, 
oesophagus and stomach followed by salivation and vomiting, 
later by dryness and an unpleasant feeling in the mouth. Sweat 
may be at first profuse, but subsequently the skin becomes dry, 
and there is a sensation of tingling and smarting followed by a 
feeling of cold, diminished sensibility, great weakness, convulsions, 
difficult breathing, loss of sight and hearing. The respirations, 
at first hurried and deepened, afterwards become shallow and 
less frequent until they stop entirely, with almost simultaneous 
arrest of the circulation so that death takes place in general col- 
lapse usually preceded by unconsciousness. 

The action of aconitine on the medulla consists of a very 
transient stimulation of the vasomotor and respiratory centres, 
followed by depression, so that a slight temporary increase 
in the force of the respirations and of the blood pressure is fol- 
lowed by a decrease. 

The heart, at first quickened for a short time, due to stimula- 
tion of the motor ganglia, is soon slowed by stimulation of the 
vagus and by depression of the ganglia. Then, the pneumogas- 
tric is also depressed and the pulse becomes more rapid. Finally, 
with further ganglionic paralysis, the heart becomes irregular 
and weaker until it stops entirely. 

The temperature is lowered by aconitine, probably due to the 
beginning of collapse. 

Fibrillary twitchings of the skeletal muscles are usually present 
in both cold and warm-blooded animals and are due to a stimu- 
lation of the motor nerve endings. Following these symptoms, 
there is a complete muscular relaxation due to a curare-like 



ACONITINE SERIES. 9 1 

paralysis of their nerve endings, while the muscles themselves 
remain unaffected. 

The alkaloids, Japaconitine, Pseudoaconitine, Delphinine 
and Staphisagrine have practically the same action as aconitine. 
Japaconitine and pseudoaconitine are more powerful while del- 
phinine is very much weaker. Staphisagrine differs from the 
others by exerting no action on the heart. 

SUMMARY OF THE GROUP ACTION.— After a brief stimu- 
lation, powerful depression of the central neroous system with death 
from respiratory paralysis and fall of blood pressure. Motor 
ganglia and vagus of the heart, sensory, motor, and secretory nerve 
endings first stimulated then depressed. 

THERAPEUTIC APPLICATION.— Aconite preparations and 
aconitine were formerly much used to lower the body temperature 
and diminish the force of the heart in different febrile conditions 
attended with high pulse, but at the present time their internal 
use has been abandoned by the greater part of the best clinicians, 
because the fall of temperature which they produce is due to or 
accompanied by collapse, which we now regard as undesirable 
in any condition. They are still employed on account of their 
local anesthetic action in the form of ointments over neuralgic 
nerves. An ointment of delphinine has been used for the same 
purpose and also to destroy pediculi. 

MATERIA MEDICA. 

Aconitum (U.S.P.), Aconiti Radix (B.P.), tubers of Aconitum Napellus 
which resemble horse-radish in appearance and taste. They contain the 
alkaloid aconitine, not less than 0.5%. 

Aconitina (U.S.P.,B.P.) is a white crystalline or amorphous body soluble 
in alcohol, insoluble in H 2 0, easily decomposed into benzaconine and acetic 
acid. The pure alkaloid has proved fatal in the dose of 0.004 G. Dose : — 
Average (U.S. P.), 0.00015 G. 

Tinctura Aconiti (U.S.P.,B. P.). Dose:— 0.2 c.c. Br. (5-15 mO- Aver- 
age (U.S.P.), 0.2 c.c. 

Unguentum Aconiti (B.P.). 

The alkaloid Japaconitine is found in Japaconitum, a Japanese aconite. 
Pseudoaconitine is found in Aconitum Ferox, while Delphinine and Sta- 
phisagrine are found in Delphinium Staphisagria. 



92 CONSTITUTIONAL ORGANIC DRUGS. 

GROUP OF CONIINE AND SPARTEINE. 

Besides Confine, we place in this group the alkaloids Gelsemine, 
Lobeline and Sparteine on account of a great similarity of action. 

CONIINE, like aconitine, depresses powerfully the central 
nervous system, after a brief primary stimulation. By its ac- 
tion the respirations are at first deepened and quickened, due to 
stimulation of the centre, but this stimulation is soon replaced 
by depression, causing death by asphyxia. 

The symptoms of poisoning are not unlike those of aconite 
and consist of a tingling sensation followed by anaesthesia, a 
feeling of cold and great weakness, usually accompanied by 
vomiting and diarrhoea. Fibrillary twitchings of the muscles, 
tremors and even convulsions may also occur. The cerebrum is 
not affected early, as consciousness may persist almost until 
death. 

This alkaloid produces first a stimulation, then a depression 
of the end apparatuses of the secretory, sensory and motor 
nerve endings. The seat of action is probably, as with nicotine, 
the ganglionic endings. As a consequence of this stimulation, 
we may observe salivation, nausea, vomiting and defecation. 

Coniine paralyzes the motor nerve endings of striated muscles 
in cold-blooded animals, just as curare. This action is but im- 
perfectly seen in the warm-blooded, because death takes place 
too rapidly from paralysis of the respiratory centre. 

The heart is first slowed by stimulation of the vagus, but later, 
it is quickened by depression of this nerve. The pupils are 
dilated, probably by local paralysis. 

The alkaloid GELSEMINE has an action almost identical 
with coniine, but is a much more powerful poison. 

LOBELINE acts in many respects like nicotine. When ad- 
ministered to warm-blooded animals, it causes an increase in the 
rate and depth of the respiratory movements, augmented reflex 
irritability, salivation and vomiting, and at last a cessation of 
respirations. Lobeline differs from coniine, as it stimulates to 
an appreciable degree the medulla, especially the respiratory 



ACONITINE SERIES. 93 

centre, and also, to a certain extent, the spinal cord. The stim- 
ulation of the medulla causes the increase in respiration and 
vomiting, while the increase in reflex irritability is due to stimu- 
lation of the cord. Ultimately, however, the central nervous 
system, particularly the respiratory centre, is paralyzed as with 
coniine. A peculiarity of lobeline is that it paralyzes the endings 
of the vagus in the lungs and therefore, has a tendency to 
diminish or check spasm of the smaller bronchi. Its action upon 
the heart or pupils is the same as that of coniine. 

SPARTEINE produces almost the same effect on the central 
nervous system as coniine, but is much weaker than the latter. 
It diminishes the force of contraction of the heart and paralyzes 
the vagus. In dogs, the pulse is at first accelerated, because of 
the paralysis of this nerve, while in rabbits and cats the depres- 
sion of the motor ganglia is paramount and the pulse is slowed 
as well as .weakened from the beginning. 

The depression of the motor nerve endings of striated muscles 
is an important feature in the action of sparteine and the paral- 
ysis of the diaphragm due to this curare-like action, is probably 
the cause of death after small poisonous doses, while after larger 
ones, death takes place from paralysis of the respiratory centre. 

SUMMARY OF GROUP ACTION.—/^ as in the preceding 
group, primary stimulation of the central nervous system followed by 
great depression and collapse. The vagus as a rule, first stimulated 
then depressed. Sensory, motor and secretory nerve endings stimu- 
lated then depressed. Motor nerve endings of striated muscles 
so much depressed that with some members this becomes a factor 
in the production of death. Pupils dilated. 

THERAPEUTIC APPLICATION.— Coniine or poisonous hem- 
lock, has no therapeutic application and is only of interest his- 
torically as being the poison used by the ancient Greeks to carry 
out the death sentence, and also because it has given rise to fre- 
quent cases of poisoning in modern times by being eaten acci- 
dentally in place of chervil or parsley, both of which it resembles 
in botanical appearance. 

Gelsemium preparations were formerly used to dilate the 



94 CONSTITUTIONAL ORGANIC DRUGS. 

pupil, but they have been entirely substituted by atropine, as 
they caused marked local irritation. 

Lobelia is employed in the treatment of asthma on account 
of its action on the ends of the vagus in the lungs and on the 
respiratory centre. It is supposed to produce good effects in 
this disease by dilating the constricted bronchi and by increasing 
the depth of respirations, thus allowing more air to enter the 
lungs. 

Sparteine was formerly administered to increase the force 
of the heart, which it does not do. It was also used as a diuretic. 
It has no such action, but the crude drug, the broom-plant, 
from which it is obtained contains a diuretic substance, Scoparin. 

MATERIA MEDICA. 

Conium (U.S. P.), Conii Fructus (B.P.), green fruits of Conium Mac- 
ulatum or poisonous hemlock, grows in Europe, Asia and Africa, and con- 
tains the liquid, oily alkaloid coniine and also methylconiine. This was the 
poison used by the Greeks to execute Socrates. 

Gelsemium (U.S. P.), Gelsemii Radix (B.P.), roots of Gelsemium Sem- 
pervirens or Yellow Jasmine. Contains the alkaloid gelsemine and gel- 
seminine. Only the latter, the amorphous gelseminine, possesses the action 
of this group. 

Fluid extractum Gelsemii (U.S.P.). Dose :— Average (U.S.P.), 0.05 
c.c. 

Tinctura Gelsemii (U.S. P.,B.P.). Dose: — 1.0-2.0 c.c. Br. (5-151$). 
Average (U.S.P.), 1.0 c.c. 

Scoparius (U.S.P.), Scoparii Cacumina (B.P.), the tops of the broom- 
plant Spartium Scoparius growing in Asia and Southern Europe. It con- 
tains the colorless liquid alkaloid sparteine and also the yellow amorphous 
scoparine which is said to have diuretic action. 

Succus Scoparii (B.P.). Dose: — 1-2 fl.5. 

Sparteine Sulphas (U.S.P.), white crystalline body with a bitter saline 
taste, soluble in water and alcohol. Dose: — Average (U.S.P.), 0.01 G. 

Lobelia (U.S.P.,B.P.), leaves and tops of Lobelia inflata or Indian To- 
bacco. Contains the alkaloid lobeline. 

Tinctura Lobeliae (U.S.P.). Dose: — Average (U.S.P.), expectorant, 
1.0 c.c, emetic, 4 c.c. 

Tinctura Lobeliae ^therea (B.P.). Dose: — 5-15 ttr. 

GROUP OF VERATRINE. 

The most typical part of the action of VERATRINE on frogs is 
seen upon the muscular system. This action consists of a 
great slowing of the relaxation period of the muscles without any 



ACONITINE SERIES. 95 

change in their rapidity of contraction. This condition is coun- 
teracted by both fatigue and cold; for either of these will make the 
veratrinized muscle relax normally. It is much more difficult to 
induce fatigue in a veratrinized muscle than in a normal one. 

Under the influence of veratrine a frog may jump naturally, 
but afterwards it draws up its legs to the trunk with great diffi- 
culty on account of the decrease in the power of relaxation of 
the extensor muscles. 

Veratrine first stimulates the peripheral endings of sensory, 
glandular and motor nerves, and also the central nervous sys- 
tem. This stimulation is soon replaced by a depression of all 
these parts. 

When a poisonous dose has been ingested by a human being, 
he first feels a burning and prickling sensation in the throat and 
stomach, which is followed by the same feeling over the entire 
body, by vomiting and by defecation, which may be bloody. 
These symptoms, as well as the sneezing which results from 
the inhalation of the powdered drug, are caused by the stimula- 
tion of the nerve endings. A sensation of numbness due to 
depression of the sensory nerves follows these symptoms of 
primary stimulation. 

The pulse at first is slow and full, due to the peculiar action of 
veratrine upon the heart muscle, and to the rise of blood 
pressure incident to the stimulant effect on the vasomotor centre. 
After this primary stimulation, the vasomotor and respiratory 
centres become depressed and the subject becomes pale, his 
pulse feeble and irregular. He feels great weakness which 
is due to the depression of the central nervous system. He 
may be seized with convulsions and fibrillary twitchings. His 
respirations become fewer and shallower. His heart grows 
gradually weaker on account of the depression of the cardiac 
motor ganglia. Consciousness remains almost intact until 
death, which takes place in this general collapse. The action 
on the circulation of warm-blooded animals is complicated by a 
stimulation of the vagus followed by a paralysis, just as with 
aconitine. 



96 constitutional organic drugs. 

The stimulation of the secretory glands is well seen in frogs 
by a coating of foam over the skin, and in dogs and cats by 
marked increased salivation. Dogs exhibit very strikingly an em- 
barrassed spastic gait, due to the peculiar action of veratrine on 
muscles. 

PROTO VERATRINE differs only from veratrine in that it does 
not paralyze the terminations of the motor nerves and does not 
prolong the relaxation period of skeletal or cardiac muscles. It 
is also much more poisonous. 

SUMMARY OF GROUP ACTION.— Central nervous system 
powerfully depressed after a primary stimulation just as by aconitine. 
Also same action on endings of sensory, motor and secretory nerve 
endings. Special action on striated muscles decreasing their 
relaxation period. Heart also slowedby a u veratrine action" on the 
cardiac muscles. 

THERAPEUTIC APPLICATION.— Veratrine, like aconitine, 
is used mainly externally in the form of an ointment, as a local 
ancBsthetic over neuralgic nerves. The crude preparations of vera- 
trum viride and veratrum album were formerly employed for 
the same purposes as those of aconite, i. e., to reduce fever and 
lower the rate of heart beat, but the same objections apply 
to such a use as to that of aconite. 

MATERIA MEDICA. 

Veratrina (U.S.P.,B.P.), a mixture of alkaloids prepared from Sabadilla 
seeds or Asagraea Officinalis (U.S. P.) or Schcenocaulon Officinale' (B. P.), in- 
cluding crystalline veratrine or cevadine, amorphous veratrine or veratridine 
and sabadilline or cevadilline. The mixture forms a whitish-gray, semicrys- 
talline powder with an acrid taste producing a tingling, benumbing sensa- 
tion in the tongue. 

Unguentum Veratrinae (U.S.P.,B.P.). 

Oleatum Veratrinae (U.S.P.).. 

Veratrum Viride (U.S.P.) , American Hellebore, contains besides vera- 
trine, jervine, pseudojervine, etc. 

Tinctura Veratri (U.S.P.). Dose: — 0.5-2.0 c.c. Average (U.S.P.) 
1.0 c.c. 

Veratrum Album, white Hellebore, contains protoveratrine, jervine, 
pseudojervine, etc. It is used on the continent in place of veratrum viride. 



GROUP OF COLCHICINE. 97 

GROUP OF COLCHICINE. 

COLCHICINE produces severe irritation of the gastrointes- 
tinal tract in a few hours after the ingestion of a sufficient dose. 
This results in great abdominal pain, cramps, vomiting and diar- 
rhoea. At first, only the normal contents of the stomach and 
bowels are expelled, but later the excreta are composed of mucus 
and blood. Severe colics and tenesmus arise and the subject falls 
into a state of collapse, accompanied by a difficulty in moving 
at first the lower, and later the upper limbs. After death the 
mucosa of the alimentary canal is found to be greatly inflamed 
and it even shows ecchymoses. 

In animals, bloody urine with albumen and casts or even total 
suppression may be observed from the severe inflammation of the 
kidneys. This irritation may explain why a few centuries ago 
colchicum was used in small doses to stimulate the action of 
these organs and relieve dropsical conditions. 

The effect on the gastro-intestinal tract and kidneys takes 
place equally well after subcutaneous administration, although 
it may be delayed for a few days, only showing at first inflamma- 
tory reactions at the place of injection. Aside from evidences 
of inflammation there is no change in the secretion of urine, 
especially no constant alteration in the quantity of uric acid, so 
that the action on the latter and gout is not supported by scien- 
tific observations. 

The central nervous system is depressed, and with sufficient 
doses death occurs from paralysis of respiration, although the 
cerebrum is but little affected as consciousness persists until the 
end. A diminution of cutaneous sensation is observed in the 
early stages of poisoning in dogs, although local anaesthesia 
does not result from topical application. 

In an ordinary case of poisoning in mammals, the heart is 
not profoundly affected, but in frogs, colchicine produces the 
same action as vera trine upon this organ, i. e., a shortening of 
the relaxation period. The skeletal muscles also show the 
typical vera trine action. 

7 



98 CONSTITUTIONAL ORGANIC DRUGS. 

Colchicine is changed in the bodies of warm-blooded animals 
to dioxy colchicine. Such a change does not take place in the 
cold-blooded. Since colchicine acts but slowly in warm-blooded 
animals, and almost not at all in the cold-blooded, unless it 
has been previously oxidized, it is believed that the action of 
colchicine is due to its oxidation product. 

COLCHICEINE also present in colchicum has the same action 
as colchicine, but in a milder degree. 

SUMMARY OF GROUP ACTION.- 1 - Intense irritation of the 
gastro-intestinal tract and kidneys. At first, very little effect upon 
the central nervous system and heart, but later, death from paralysis of 
respiration. In animals, decrease in cutaneous sensation not due 
to paralysis of peripheral nerve endings. In frogs, veratrine action 
on heart and skeletal muscles. 

THERAPEUTIC APPLICATION.— The first use of colchicum 
in therapeutics was as a diuretic in dropsical conditions ; then this 
application was laid aside and it was given chiefly in gouty and 
rheumatic affections, but of late it has not been so popular be- 
cause of its frequent failure to cure and also because if often 
occasions very troublesome inflammations of the gastro-intestinal 
tract. It is possible that colchicum improves some cases of 
gout by its analgesic power, or it may be that the good effects 
sometimes observed come from some influence on the general 

metabolism. 

MATERIA MEDICA. 

Colchici Cormus (U.S.P.) and Colchici Semen (U.S.P.,B. P.), the root 
and seeds of Colchicum Autumnale or meadow saffron, a plant growing in 
Europe and North Africa. It contains two active bodies, colchicin and 
colchiceine. 

Vinum Colchici (U.S.P.,B. P.). Dose: — 0.5-2.0. Br. (10-30 ffg). Aver- 
age (U.S.P.), 2.0 c.c. 

Colchicina (U.S.P.) is an amorphous, white or yellow nitrogenous body 
with an acid reaction, which crystallizes out of chloroform with two mole- 
cules of the latter. It is the methyl ester of colchiceine and is soluble in 
alcohol and water. Dose: — Average (U.S.P.), 0.0005 C. 

GROUP OF EMETINE AND APOMORPHINE. 

We include in this group different substances which are used 
in practical medicine, in. large doses, to induce vomiting or in 



GROUP OF EMETINE AND APOMORPHINE. 99 

small doses, to increase the bronchial secretion. This increase 
is a secondary action brought about by the first stage of nausea 
and is equivalent to that observed in spontaneous nausea and 
vomiting or in seasickness. 

The chief members of the group are certain alkaloids, Em- 
etine and Cephaline found in Ipecacuanha, Quebrachine, As- 
pidosamine, etc., found in the Quebracho bark, and lastly 
Apomorphine, the artificial emetic, made by boiling morphine 
with hydrochloric acid. 

EMETINE when given to a man in small doses, produces a 
feeling of nausea and a marked increase in the bronchial secretions, 
but if the dose is large, vomiting occurs in from half an hour to 
an hour and may be repeated a few times until the drug has 
been all ejected from the stomach. Diarrhoea frequently accom- 
panies vomiting, and in dogs, marked inflammation of the stomach 
and intestines is usually observed. On postmortem examination, 
the mucous membrane is swollen, reddened and contains many 
ecchymoses just as after arsenical poisoning. Such evidences of 
irritation of the gastro-intestinal tract may even be observed 
after subcutaneous administration, a fact which tends to show 
that this drug is excreted, at least in part, by the stomach and 
bowels. The site of injection also shows marked inflammation 
and often pustulation. The kidneys are frequently irritated. 

All these evidences of local irritation and the fact that the 
vomiting is not very prompt, suggest that the emesis is due to 
a local action on the stomach rather than to stimulation of the 
vomiting centre. 

In warm-blooded animals the blood pressure is lowered, and 
death takes place from paralysis of the heart when emetine is 
given in sufficient doses intravenously or subcutaneously. Cold- 
blooded animals also show a paralysis of the heart muscle, of the 
central nervous system and a decrease of the irritability of the 
striated muscles. 

APOMORPHINE is the most excellent emetic, for it acts in a 
specific way by stimulation of the vomiting centre. When given 
to a man or dog subcutaneously in sufficient doses, it causes pro- 



IOO CONSTITUTIONAL ORGANIC DRUGS. 

fuse vomiting within three to ten minutes, usually accompanied 
and preceded by the symptoms of emesis, i. e., nausea, great 
weakness, muscular relaxation and accelerated pulse. These may 
at times be entirely omitted. Occasionally the weakness is so 
great that actual collapse occurs. 

The action is not so rapid by internal administration, because 
it takes longer for absorption and reaches more slowly the centre 
of vomiting. Very small doses, taken internally, may produce 
only nausea, muscular relaxation, increase in the bronchial and 
salivary secretions and in the pulse rate. 

Large doses administered to warm-blooded animals cause 
marked stimulation of the central nervous system, especially 
of the brain and medulla. Rabbits and cats become restless 
and their breathing is hurried. They move about to and fro 
violently and even go into convulsions. These symptoms of 
excitement at last pass away and the animals fall on the side 
relaxed, and die from paralysis of respiration. 

Paralysis of the striated muscles and heart is a striking 
symptom in frogs, but not in warm-blooded animals. 

Apomorphine is excreted neither by the stomach nor bronchial 
tract, and in fact it is not found in any of the excretions. It is 
probable that the increase in bronchial secretions is due to the 
first stage of nausea, rather than to direct action. 

The Quebracho Alkaloids, Aspidospermine, Aspidosperma- 
tine, Aspidosamine, Quebrachine, etc., produce practically the 
same symptoms as apomorphine. Among these only Aspido- 
samine produces vomiting after subcutaneous administration. 
This action is, as that of apomorphine, also on the vomiting centre. 
All these alkaloids produce marked local irritation. 

SUBGROUP OF SAPOTOXIN AND SOLANINE. 

SAPOTOXINS are active glucosides found in plants as Sapo- 
naria, Sarsaparilla, Quillaja, Senega and Cyclamen, which although 
soluble in water are not absorbed from the gastro-intestinal tract. 

When taken internally in large doses they produce severe 



SUBGROUP OF SAPOTOXIN AND SOLANINE. 1 01 

irritation of the gastro-intestinal tract, resulting in nausea, 
increase in bronchial secretions, vomiting, pain in the abdomen 
and diarrhoea. 

When injected subcutaneously or intravenously, besides irrita- 
ting the place of application, they produce in small doses symp- 
toms of gastro-intestinal and renal inflammation, and in larger 
doses convulsions due to stimulation of the central nervous 
system. Finally, they cause failure of respiration and the other 
symptoms resulting from paralysis of the central nervous system. 

Applied directly to the blood, even in very great dilution, 
they dissolve the red corpuscles. They paralyze striated and 
cardiac frog muscles just as do emetine, apomorphine and the 
quebracho alkaloids. 

SOLANINE, the poison found in germinating potatoes and in 
other members of the Solanaceae family, resembles the sapotoxins 
in its action. 

It is a very powerful local irritant which may produce ab- 
scesses at the site of injection, also violent vomiting and diarrhoea 
if given internally. It is absorbed with great difficulty, so must 
be given intravenously in order to observe the general action. 

This consists, at first, of a stimulation of the central nervous 
system followed by paralysis. After a stage of convulsive 
muscular contraction and general convulsions, there come deep 
coma and death due to respiratory failure. 

After intravenous injection, solanine causes a breaking up of 
the red blood corpuscles with hemoglobinuria and acute paren- 
chymatous nephritis. 

In different cases of poisoning in man from taking solanine 
internally to study its effects, or after eating germinating, unripe 
or decaying potatoes, the symptoms have been nausea, vomiting, 
diarrhoea with great colic and abdominal tenderness, sleepiness, 
dizziness, sometimes cramps in the extremities, and difficulty in 
breathing. 

HELVELLIC ACID found in the edible mushrooms, the morels, 
at times gives rise to cases of poisoning, when the latter are eaten 
improperly prepared. Being very soluble in water, helvellic 



102 CONSTITUTIONAL ORGANIC DRUGS. 

acid is easily dissolved out of the mushrooms by boiling with 
water; this makes them entirely harmless. Drying and keeping 
for a period of time, also destroys the poisonous principle. 

The symptoms of poisoning in man consist of violent vomit- 
ing, sometimes accompanied by diarrhoea, dulling of the in- 
tellect, stupor, delirium, dilated pupils, convulsions, and at times 
a slight icteric coloration of the skin. Beyond the mild icterus 
no other evidence of destruction of red corpuscles occurs. 

The prominent symptom in dogs after intravenous injection 
is a destruction of red blood corpuscles which gives rise to a 
deposition of the haemoglobin in all the organs. The kidneys 
are much irritated and their secretion contains albumen, blood, 
coloring matter and casts. 

SEPSIN, a basic body obtained from decomposed meat, yeast 
and so forth, and produced by the Proteus Vulgaris, has a phar- 
macological action very closely resembling that of emetine. 

When administered internally to a dog, it causes nausea and 
vomiting and is quickly expelled. If, however, it is given sub- 
cutaneously or intravenously, it causes also irritation of the 
gastro-intestinal tract which takes the form of vomiting and 
diarrhoea, consisting at first of the normal contents, then of a 
bloody fluid and even at last of pure blood. It causes death, 
either from the collapse incident to the violent gastro-intestinal 
disturbances, or in large doses from direct paralysis of the central 
nervous system. 

At autopsy, it is found that the seat of action is chiefly at the 
pyloric end of the stomach, at the duodenum and rectum, while 
the Peyer's patches which are so much affected by ricin escape 
intense inflammation. Besides those ecchymoses present in the 
intestines, there are also some in the lungs, liver and spleen; 
the latter may contain hemorrhagic infarcts. 

It is probably a fact that many of the milder cases of poisoning 
from tainted meat, which show only gastro-intestinal symptoms, 
are due to the presence of sepsin; but this form of poisoning must 
not be confounded with botulism which is much more serious 
and exhibits many nervous symptoms. 



SUBGROUP OF SAPOTOXIN AND SOLANINE. 1 03 

SUMMARY OF ACTION OF EMETINE GROUP AND 
SAPOTOXIN SUBGROUP.— The production of emesis with its 
attending symptoms, increased bronchial secretion, nausea, muscular 
relaxation, general weakness and quick pulse. Irritation of the in- 
testinal tract leading to diarrhoea. Depression of the heart and 
striated muscles and also of the central nervous system after sub- 
cutaneous administration. 

THERAPEUTIC APPLICATION.— Formerly vomiting was in 
current use for almost all sicknesses. Then, flourished ipecac; 
but nowadays, we find so few indications for it that the members 
of this group have lost much of their importance in therapeutics. 
Even in cases of poisoning, one of the few occasions to cause 
emesis, we usually prefer the stomach tube. 

In the nauseated stage preceding vomiting, the bronchial 
secretion is always increased so that all emetics can be used in 
very small doses as expectorants. 

Among the members of these groups, crude preparations of 
quillaja, senega, sarsaparilla containing sapotoxines and 
saponines, also quebracho and ipecac are especially applicable 
for expectorant use, but on account of the disagreeable, nauseated, 
weak feeling which they cause, are inferior to the direct expector- 
ant, as for example, the ammonium salts. 

Apomorphine, which is crystalline and rapidly absorbed, 
is not so suitable as an expectorant, because its action is too 
rapid and of too short duration. It is the ideal emetic. It pro- 
duces vomiting in man in from five to ten minutes after a dose 
of 0.005 G. It is sometimes used in cases where there is an in- 
dication to empty the stomach of offending material, as of poison- 
ing by drugs or decomposed food. Its use is contraindicated in 
narcotic poisoning because the vomiting centre may be paralyzed 
and incapable of stimulation. 

Ipecac preparations are used mainly as emetics for children 
and in small doses as expectorants for adults. They are some- 
times employed in minute quantities to stimulate the gastric 
mucous membranes in atony of the stomach. Ipecac has been 
recommended as a valuable remedy for tropical dysentery. It 



104 CONSTITUTIONAL ORGANIC DRUGS. 

may act in such cases purely as a local irritant in stimulating 
the processes of repair, or it may influence the causative agent. 
It is used especially in the form of Dover's powders to produce 
sweating in acute colds. The sweating is probably of a reflex 
origin from irritation of the gastro-intestinal tract. 

Besides its use as an expectorant, sarsaparilla has been em- 
ployed a great deal in the disease syphilis. It was at one time 
thought to have specific action, but now we believe that what 
benefit may be produced can be attributed to the improvement 
of the general metabolism on account of the stimulant action on 
the gastro-intestinal tract. It also serves as a vehicle for the 
administration of badly tasting drugs. 

MATERIA MEDICA. 

Ipecacuanha (U.S. P.), roots of Cephaelis Ipecacuanha, a small shrub 
growing in Brazil, Bolivia and Peru, and Ipecacuanhae Radix (B.P.), the 
dried roots of Psychotria Ipecacuanhae. They contain the alkaloids eme- 
tine and cephaeline, both of which are quinoline derivatives. Emetine is 
easily decomposed, by standing, into a brown body, which has lost its powers, 
and is therefore not used in medicine. Dose: — As emetic. Average 
(U.S. P.), i.o G. Br. (15-30 grains). As expectorant. Average (U.S. P.), 
0.065 G. Br. (}4-2 grains). 

Syrupus Ipecacuanhae (U.S.P.). Dose: — Average (U.S.P.), 1.0-16.0 
c.c. 

Vinum Ipecacuanhae (U.S.P.,B.P.). Dose: — Average (U.S. P.), 1.0 
c.c. Br. (10 tu7 — 6 fl.5). 

Aspidosperma or Quebracho is the bark Aspidosperma Quebracho, a 
tree growing in Argentine and Chili. It contains the following alkaloids, 
aspidosamine, aspidospermine, aspidospermatine, quebrachine, hydro- 
quebrachine and quebrachamine. 

Fluidextractum Aspidospermatis. Dose: — 0.3 c.c. 

Apomorphinae Hydrochloridum (U.S. P. ,B. P.), is composed of minute, 
grayish crystals, soluble in 39 parts of water, turns dark by exposure to light 
without loss of strength. It is made by heating morphine with hydrochloric 
acid and is chemically morphine less one molecule of water. Dose: — 
0.005-0.015 G. Br. (2V-T0 grain). Average (U.S. P.) expectorant, 0.002 
G., emetic, 0.005 G. 

SAPONIN BODIES. 

Sarsaparilla (U.S. P.), is the root of Smilax Officinalis and Sarsae Radix 
(B.P.), large climbers growing in tropical America. They contain the 
active glucoside parillin and also saponin. 

Fluidextractum Sarsaparillae (U.S. P.). Dose: — 2.0-5.0 c.c. Average 
(U.S.P.), 2.0 c.c. 

Extractum Sarsae Liquidum (B.P.). Dose: — 2-4 fl.3. 



GROUP OF ERGOTOXINE. 105 

Syrupus Sarsaparillae Compositus (U.S. P.). Dose: — 10.0-15.0 c.c. 
Average (U.S.P.), 16.0 c.c. 

Quillaja (U.S.P.), Quillajae Cortex (B.P.), is the inner bark of Quillaja 
Saponaria, a tree growing in South America and India. It contains besides 
the inoffensive saponin, the very poisonous quillaja sapotoxine and quillaic 
acid. 

Fluidextractum Quillajae (U.S. P.). Dose: — Average (U.S.P.),o.2 c.c. 

Tinctura Quillajae (B.P.). Dose: — 2.0-5.0 c.c. Br. (30-60 mj). 

Senega (U.S. P.), Senega Radix (B.P.), is the root of Polygala Senega, 
a tree growing in the United States and Canada. It contains senegin, poly- 
galin and saponin. 

Fluidextractum Senegae (U.S. P.). Dose: — 0.5-2.0 c.c. Average 
(U.S.P.), 1.0 c.c. 

Syrupus Senegae (U.S. P.). Dose: — 5.0-8.0 c.c. Average (U.S.P.), 
2.0 c.c. 

Tinctura Senegae (B.P.). Dose:— ^-1 fl.5. 



GROUP OF ERGOTOXINE. 

For many years, extracts of ergot, the parasitic fungus which 
grows on rye or maize, have been employed to aid labor in preg- 
nant women, also to arrest hemorrhage after parturition. 

The ingestion of ergotized rye and maize which is prevalent 
in certain parts of southern Russia and Italy, has given rise to 
quite severe epidemics of poisoning. These take the form of 
two types: the gangrenous, accompanied by dry necrosis of 
tissues, and the convulsive, accompanied by spasmodic seizures 
and contractions. 

Until the masterly work of Barger and Dale, scores of active 
principles were attributed to ergot and among these figures 
sphacelotoxin, cornutin, secalin, ergotin, etc. At present we 
know definitely from the research of these experimenters that the 
characteristic action of ergot is due to the alkaloid, ergotoxin, 
and to a smaller extent to tyramine, a body resembling closely 
adrenalin in both chemical structure and action. 

Ergot and the active principle, ergotoxin, induce marked con- 
traction of the uterus, due to stimulation of the motor-nerve 
endings. This effect is more marked in pregnant animals and 
may induce abortion. Given during labor, ergot may materially 
aid the expulsion of the fetus and after labor it may prevent post- 
partum hemorrhage by contracting the relaxed uterus and closing 



106 CONSTITUTIONAL ORGANIC DRUGS. 

the bleeding sinuses. Tyramine, like adrenalin, sometimes 
contracts the uterus and sometimes relaxes it, because it has in 
addition to the action on the motor-endings, a marked one on the 
inhibitory nerves. 

Both alkaloids produce an action absolutely analogous to that 
of adrenalin upon the circulation. They cause a great imme- 
diate rise of blood pressure due to constriction of all peripheral 
blood vessels, which in turn is the result of stimulation of the 
constrictor nerve-endings in the vessel walls. Prolonged ad- 
ministration of these substances may produce such powerful and 
long-lasting constriction of the smaller vessels, that hyaline 
thrombosis and gangrene may result. In animals, classical ex- 
periments upon cocks' combs and pigs' ears invariably demon- 
strate this action. Very few doses given internally are necessary 
to produce gangrene of the rooster's comb. 

The pupils undergo a powerful constriction after the intra- 
venous application of these substances, although the same may 
be preceded by a momentary dilatation. This constriction is 
due to direct effect on the muscle fibers. 

Some evidence of medullary stimulation is seen in the slowing 
of the heart. It has not been proved whether the convulsions 
are due to stimulation of the convulsive centers or of the cord. 
Large single doses seem to produce death from paralysis of the 
central nervous system. 

The vomiting and diarrhea which is sometimes observed after 
ergot may be the result of the action of the sapotoxins present in 
crude preparations or of the specific alkaloids themselves. 

ERGOTINIC ACID, another constituent of ergot, has none of 
the action of this group. It acts like the sapotoxines and merely 
produces irritation of the gastro-intestinal tract, but no general 
symptoms after internal administration. Yet, after subcuta- 
neous or intravenous injections, it produces paralysis of the 
nervous system just as the sapotoxins. 

Acute ergot poisoning in man, consists mainly of gastro-in- 
testinal irritation with nausea, vomiting and diarrhoea, and of 



SUBGROUP OF HYDRASTINE. IO7 

stupor, collapse and death from failure of respiration; the latter 
may be preceded by convulsions. 

Chronic poisoning, which occurs in countries where ergoted 
rye or maize is eaten, can be divided into two types, the con- 
vulsive and the gangrenous. 

The convulsive type begins with headaches, heaviness of the 
head, dizziness, roaring in the ears, and the especially character- 
istic symptom of formication which lasts through the whole 
disease; also, a feeling of anaesthesia in the fingers and toes, great 
thirst, vomiting, colics, diarrhoea and in the severer cases twitch- 
ings and painful clonic and tonic contractions of different muscles, 
especially the flexors. Tetanic or epileptiform attacks occur until 
death results, either from exhaustion or from the convulsions. 

The gangrenous type presents about the same symptoms at 
the beginning, but in a few days or weeks, there occurs in different 
parts of the limbs a feeling of cold and deadness followed by 
dry gangrene. The toes and feet are more likely to be affected 
than the fingers and hands. Whole toes may drop off and death 
may result from exhaustion or secondary infection. 



SUBGROUP OF HYDRASTINE. 

HYDRASTINE, from Hydrastis, produces at first, a stimulation 
of the medulla and then of the cord which result in increased 
respiration, a rise of blood pressure, a slowing of the pulse and 
convulsions. These symptoms are quickly followed by those of 
paralysis and there occurs decreased respiration, increase in 
pulse rate and fall of blood pressure. The latter is due to both 
depression of the medulla and paralysis of the heart muscle. 
The rise of arterial tension may be elicited with doses insufficient 
to cause increase in reflexes or general paralysis. 

HYDRASTININE, an artificial substance, formed from hydras- 
tine, produces much less action on the central nervous system 
than the latter, although in large doses it also produces death 
from paralysis of respiration. 

It always causes a contraction of peripheral blood vessels, 



108 CONSTITUTIONAL ORGANIC DRUGS. 

due both to local and central action, in a more marked degree 
than hydras tine. 

It does not paralyze the heart as does its antecedent, but may 
even augment its strength. It also increases the power of the 
skeletal muscles in frogs, but it has not been shown to improve 
the contractions of the uterus. 

SUMMARY OF ACTION OF THE ERGOTOXINE GROUP 
AND HYDRASTINE SUBGROUP.— Powerful contraction of the 
pregnant uterus and also of smooth muscles in the walls of blood 
vessels; the former aiding expulsion of the contents of uterus and 
diminishing hemorrhage of this organ; the latter increasing the 
general blood pressure. At first, stimulation of the central nervous 
system followed by depression with death from failure of respiration. 
Chronic ergot poisoning consisting of two types, convulsive and 
gangrenous. 

THERAPEUTIC APPLICATION.— On account of the con- 
tracting action on blood vessels, the substances of these groups, 
especially in the form of crude preparations of ergot and hydras- 
tis, have been used a great deal in former times to arrest hemor- 
rhage from internal organs. This use is not strictly rational be- 
cause the contraction of vessels is accompanied by a rise of blood 
pressure which would obviously tend to overcome the good 
effects, i. e., decrease in amount of bleeding and formation of 
clot: therefore favorable results were rarely obtained. 

Nowadays, these drugs are used almost exclusively for hem- 
orrhage in the uterus. Here the action is very marked because 
besides a contraction of the vessel wall, we have at least in the 
case of ergot, a contraction of the uterine fibres around the bleed- 
ing vessels which closes their apertures. 

Ergot is employed to arrest hemorrhage in the uterus from any 
cause, but especially after parturition. It is also used to remove 
submucous fibroids and this result is brought about by cutting 
off their blood supply. It is of service to aid the subinvolution of 
the uterus after child birth or abortion. 

Hydrastis and its preparations are used mainly to arrest 
hemorrhage from the uterus not connected with pregnancy, and 



GROUP OF DIGITOXIN. 109 

to decrease too profuse menstruation. Crude preparations of 
Hydrastis are also used as tonics on account of the bitter ber- 
berine which they contain. 

MATERIA MEDICA. 

Ergota (U.S.P.,B.P.), sclerotium of Claviceps Purpurea, is a fungus re- 
placing grains of rye. It grows in Southern Europe and contains Ergotoxine, 
Tyramine and Ergotinic Acid. 

Fluidextractum Ergotae (U.S.P.). Dose: — 2.0-4.0 c.c. Average 
(U.S.P.) 2.0 c.c. 

Extractum Ergotae (U.S.P.,B.P.). Dose 1-0.3-1.0 G. Br. (2-8 
grains.) Average (U.S.P.) 0.25 G. 

Vinum Ergotae (U.S.P.). Dose: — 4.0-16.0 c.c. Average (U.S.P.) 
8.0 c.c. 

Hydrastis (U.S.P.), Hydrastis Rhizoma (B.P.), or Golden Seal, roots 
of Hydrastis Canadensis which contains the alkaloids hydrastine, berberine 
and canadine. Canadine is present in such small traces that it does not 
influence the action of the crude drug. It acts like morphine. Berberine 
is almost inactive. 

Hydrastina is a white crystalline alkaloid, soluble in alcohol and in- 
soluble in water. 

Hydrastininae Hydro chloridum (U.S.P.), artificial alkaloid formed by 
the oxidation of hydrastine. Dose: — 0.01-0.05 G. Average (U.S.P.) 
0.03 G. 

Fluidextractum Hydrastis (U.S.P.). Dose: — 0.3-4.0 c.c. Average 
dose (U.S.P.) 2.0 c.c. 

Tinctura Hydrastis (U.S.P.,B.P.). Dose:— 0.5-2.0 c.c. Br. (15-60 
ttjj). Average (U.S.P.) 1.0 c.c. 

Glyceritum Hydrastis (U.S.P.). Dose: — 0.3-4.0 c.c. Average dose 
(U.S.P.) 2.0 c.c. 

Stypticin (Methoxyhydrastinine) , is the same as cotarnin and is obtained 
by decomposing narcotin. It is a white crystalline body with physiological 
action and uses similar to hydrastinine. Dose : — 0.02-0.03 G. 



GROUP OF DIGITOXIN. 

"Heart poisons" or "heart tonics" are the names sometimes 
given to the large list of substances belonging to this group. 
The best known and most characteristic members are the active 
principles extracted from the leaves of Digitalis or Foxglove, 
i. e., Digi toxin, Digitalin and Digitalein. 

Crude drugs containing various members of this group were 
employed by the Ancients ; but the action on the pulse was first 
described by the English clinician Withering in the 18th cen- 
tury. Although he recommended digitalis only as a diuretic 



IIO CONSTITUTIONAL ORGANIC DRUGS. 

to remove accumulated fluid, yet he claimed that the good effect 
was best seen when the pulse was weak and that its use was 
followed by a great increase in the quantity of urine voided, 
accompanied by # marked strengthening in the force of the 
pulse with a diminution in its rate. 

When a solution of DIGITOXIN is administered to a fenes- 
trated frog, there is to be observed, at first, a great increase in the 
force of contraction of the heart. It becomes white in systole on 
account of the very complete emptying of the ventricles; the 
rate of beat is much slowed; later, it becomes irregular and 
peristaltic waves are seen going over the organ, and, at last, the 
heart stops suddenly and completely contracted in systole. If 
at this moment the organ is distended by a column of fluid, it 
starts to beat again very energetically as long as the pressure is 
increased to a certain point, and when this point is reached, the 
heart loses its irritability and stops for good. These facts seem 
to show that the stoppage of the frog's heart in systole is not due 
to a loss of contractility but rather to a loss of elasticity. This 
loss of elasticity causing systolic arrest takes place only in the 
inner layers of the muscles of the heart, because if by a special 
apparatus, digitoxin is applied only to the outer surface, then 
this organ shows the increase in pulse volume and the slowing 
of rate but stops in diastole instead of systole. 

The increase in force of the frog's heart under digitoxin is suffi- 
cient alone to raise materially the blood pressure because if this 
organ is isolated and blood vessels are excluded by connecting 
it with a glass vascular system, the result is a marked rise of 
arterial tension. 

In warm-blooded animals also, the main action of these 
substances is seen upon the heart. At first, the force of this 
organ and capacity for work is greatly increased, the rate is as a 
rule decreased, then with large doses the force is diminished, it 
becomes irregular and stops completely. 

The action of digitoxin upon the heart may be divided into 
four stages. The first consists of an increase in the force of con- 
traction due to direct stimulation of the cardiac muscle, usually 



GROUP OF DIGITOXIN. Ill 

accompanied by a diminution in rate secondary to stimulation 
of the vagus, both centrally and peripherally. The blood pres- 
sure rises, chiefly as a result of this increased force of the muscle. 
The second stage consists of a further increase in force, but also 
of an increase in rate due to depression or exhaustion of the vagus. 
The blood pressure is still high. In the third stage the blood 
pressure is high, but irregular, as is also the pulse. This is due 
to beginning exhaustion of some cardiac fibres. In the fourth 
stage the blood pressure falls, accompanied by great irregu- 
larity in rate and force of the heart's contraction. In warm- 
blooded animals, the heart stops paralyzed in diastole, but as 
mentioned before in the cold-blooded, as the frog and turtle, it 
stops in systole. 

The amount of vagus action varies considerably in different 
individuals. There are cases in human beings, especially in 
febrile conditions, when the stimulation of this nerve is not ob- 
served and the pulse is not slowed. On the contrary, others 
show a very strong stimulation of the pneumogastric, which 
may make the pulse dangerously slow. 

Although the force of the pulse is raised by digi toxin in the 
presence of paralysis of the blood vessel walls, yet it is possible 
that under normal conditions the vasomotor system is stimu- 
lated centrally and peripherally and that this condition assists 
in the raising of the arterial tension. Digitoxin seems to contract 
at least temporarily the vessels of the limbs and of the splanchnic 
area. Digitalin and strophanthin seem to contract those of the 
splanchnic area only, but to dilate the vessels of the limbs and 
brain. 

No increase in the flow of urine is seen after the use of the 
digitoxin series in normal human beings, but in dropsical con- 
ditions, especially those due to weakness of the heart, a great 
diuresis may be observed. This diuresis is, therefore, not due 
to a direct action upon the renal epithelium, but rather to the in- 
creased circulation through the kidney incident to the rise in blood 
pressure. 

Few symptoms referable to the central nervous system are 



112 CONSTITUTIONAL ORGANIC DRUGS. 

observed during the action of small doses of digitoxin. The 
convulsions which occur near death after poisoning with digi- 
talis are probably due in part to stimulation of the convulsive 
centre in the medulla, and in part to the asphyxia, which results 
from the failing circulation. 

An exceedingly important action of the digitalis group is the 
local irritant one. This is sometimes so severe as to produce 
after internal administration, nausea, vomiting, diarrhoea with 
marked inflammation of the gastro-intestinal tract, and after sub- 
cutaneous injection, abscess and sloughing. The nausea and 
vomiting caused by the heart poisons is sometimes so distressing 
as to force the discontinuance of the internal administration in 
some cases of cardiac insufficiency. 

Habit or tolerance is never noticed even after using digitalin, 
digitoxin or strophanthin for periods or months, and, with suitable 
doses the increase in the pulse volume and decrease in pulse 
rate are as obvious at the end as at the beginning of the period. 
On the other hand, if the dose has been rather large, evidences 
of cumulative effects may occur, as in the case of Prof. Koppe, 
who had taken on three successive days a large dose of digitoxin 
and who showed on the fourth day alarming symptoms of car- 
diac failure. Other less serious symptoms of overdoses or of 
cumulative effects are the following: irregularity of a previously 
regular pulse with quickening, also a feeling of pressure and 
pain around the heart, sometimes dizziness and specks before the 
eyes and a sensation of great weakness and dyspnoea. Marked 
delirium and hallucination sometimes occur and are probably due, 
as are most of the other symptoms, to disturbance of the circula- 
tion. 

STROPHANTHIN has an action on the heart almost identical 
with that of the digitalis active principles. 

It differs from digitoxin in dilating the vessels of the limbs and 
brain which are contracted by the former ; but strophanthin like 
digitoxin also contracts those of the splanchnic area. 

Recent work has shown that the action of strophanthin is much 
less certain by oral or subcutaneous than by intravenous admin- 



GROUP OF DIGITOXIN. 113 

istration because this glucoside is rapidly destroyed and ex- 
creted. In fact, Hatcher found that it took ten times the sub- 
cutaneous fatal dose when given by mouth to produce toxic 
symptoms in animals. Strophanthin has decided local anesthetic 
properties. 

The other members of this group, as Scillain, Convalla- 
marin, Helleborin, Bufonin, Bufotalin, Erythrophlein, etc., 
have practically the same qualitative action as digitoxin, digita- 
lin, and digitalein. Erythrophlein has to a certain extent, local 
anaesthetic action. 

SUMMARY OF GROUP ACTION ^Intense stimulation of 
cardiac muscles causing increase in the force of the pulse and a rise of 
blood pressure, with medicinal doses. Depression of the heart 
muscle with irregularity, fall of blood pressure and death from 
cardiac failure with large toxic doses. Arrest of the heart in diastole 
in warm-blooded but in systole in cold-blooded animals. At first, 
stimulation of the vagus with slowing of pulse followed by the de- 
pression of this neroe and a quickened pulse. Marked local irrita- 
tion sometimes leading to vomiting and diarrhoea after internal ad- 
ministration. Tremendous increase in the flow of urine in dropsical 
conditions due to uncompensated heart. Central neroous system 
but secondarily affected and action on these parts of but little im- 
portance in poisoning. 

THERAPEUTIC APPLICATION.— The indication par ex- 
cellence for the use of the heart tonics is in conditions where the 
heart is accomplishing an insufficienl work and where the blood 
pressure is too low, and the arteries improperly filled. The main 
use, therefore, is in the treatment of cardiac diseases, especially 
those of valvular origin, either stenosis or insufficiency. 

Digitalis and allied substances are indicated in these con- 
ditions only when the heart is incapable of doing its normal 
work, and especially when such symptoms of incompetency as 
cyanosis, dyspnoea or dropsy are present. These drugs often 
have remarkable action in reducing the size of a dilated heart, 
and also in producing a compensatory hypertrophy. The dim- 
inution in the rate of the pulse should not be used alone as a 



114 CONSTITUTIONAL ORGANIC DRUGS. 

criterion of the good results of digitalis, for irritability of the 
vagus may be decreased from one cause or another. Then the 
pulse will not be decreased in rate, although the heart may be 
much strengthened and the dyspnoea, cyanosis and oedema may 
have disappeared, while the urine is increased in quantity. 

In toxaemias where there is much acute myocardial degeneration, 
no good effects may be seen after the administration of members 
of the digitalis group. When compensatory hypertrophy is 
reached and when no symptoms of failing compensation are 
present, these substances are contraindicated. Great caution 
should be observed when .much myocarditis is present, as these 
drugs may strain the heart and produce a sudden stoppage. 
They can be used with good effect in pericarditis and in condi- 
tions where the circulation through the lungs is impeded as in 
phthisis, pneumonia and pleurisy. 

Great difficulty has been met in the past in obtaining a reliable 
digitalis preparation, since the leaves spoil rapidly, likewise the 
preparations made from them. Now a number of firms stand- 
ardize their tinctures and fluidextracts. In Germany, the two 
most important standardized products have been Digalen and 
Digipuratum. 

A few years ago, Fraenkel used and recommended intravenous 
injection of Strophanthin in the dose of one milligram in twenty- 
four hours. He and others showed series with strikingly good 
results. 

MATERIA MEDICA. 

Digitalis (U.S.P.), Digitalis Folia (B.P.), leaves of Digitalis Purpurea or 
Foxglove, contain the glucosides digitalin, digitalein, and digitophyllin, and 
the neutral body digitoxin, all of which possess the characteristic digitoxin 
action. Besides these, are present to a small extent two resins, one, toxiresin, 
derived from the decomposition of digitoxin and the other, digitaliresin, from 
that of digitalin. They do not act like digitoxin, but belong to the picrotoxin 
group. A member of the saponin group is also present in digitalis, i. e., 
digitonin. The leaves which are official, contain mainly digitoxin, and digi- 
tophylline, while the seeds contain digitalin and digitalein. 

Digitoxin is a neutral body soluble in alcohol, insoluble in water. It is 
absorbed with difficulty, but also excreted with difficulty so that its effects 
are cumulative. It is very irritant locally. Dose : — o.oooi G. 

Digalen, special solution of amorphous digitoxin in water and glycerine. 
Dose: — 1.0-2.0 c.c. 



GROUP OF DIGITOXIN. II 5 

Digitalin and Digitalein are soluble in water. They are much weaker 
than digitoxin. Digitalin is decomposed in the stomach by the gastric 
juice, but it may be administered subcutaneously as it is not very irritating. 
Dose: — 0.0002-0.0006 G. 

Digitalin Verum, pure preparation of Digitalin. Dose: — 0.0002- 
0.0005 G. 

Tinctura Digitalis (U.S.P.,B.P.). Dose:— 0.3-2.0 c.c. Br. (5-15 ttjj). 
Average (U.S. P.) 1.0 c.c. 

Fluidextractum Digitalis (U.S.P.). Dose: — 0.01-0.2 c.c. Average 
(U.S.P.) 0.05 c.c. 

Infusum Digitalis (U.S.P.). Dose: — 4.0-16.0 c.c. Average (U.S.P.) 
8.0 c.c. 

The tincture and nuidextract contain a larger percentage of digitoxin 
than the infusion because the latter is more easily extracted by alcohol. 

Strophanthus (U.S.P.), seeds of Strophanthus Hispidus and Strophan- 
thus Semina (B.P.), seeds of Strophanthus Kombe, containing the non- 
glucosidal bitter principle, strophanthin. 

TincturaStrophanthi(U.S.P.,B.P.). Dose:— 0.1-0.6 c.c. Br. (5-15115). 
Average (U.S.P.) 0.5 c.c. 

Strophanthinum-Thoms. cryst. glucoside obtained from Strophanthus 
gratus and identical with ouabain. Is colorless, soluble in hot water and 100 
parts cold water, 30 parts alcohol. Dose: — By mouth, 0.003-0.025 G. 
intravenously, or intramuscularly 0.0005 G. 

Scilla (U.S.P.,B.P.), Squills, bulbs of Urginea Maritima or Broom, con- 
taining the brown bitter glucoside scillain, insoluble in water, soluble in 
alcohol. 

Tinctura Scillae (U.S.P.,B.P.). Dose:— 0.3-2.0 c.c. Br. (5-15 ttjj). 
Average (U.S.P.) 1.0 c.c. 

Fluidextractum Scillae (U.S.P.). Dose: — 0.03-0.2 c.c. Average 
(U.S.P.) 0.1 c.c. 

Other members of the digitoxin group are the following substances : 

Convallamarin, glucoside soluble in alcohol, extracted from the Con- 
vallaria Majalis or Lily of the Valley. 

Helleborin, glucoside soluble in water, and Helleborein insoluble in 
water, both from Helleborus Niger. 

Apocynein and Apocynin from Apocynum Cannabinum or Canadian 
Hemp. 

Euonymin from Euonymus Atropurpureus. 

Adonidin from Adonis Vernalis. 

Antiarin from Antiaris or Upastree. 

Neriin from Nerium or Oleander. 

Thevetin from Thevetia. 

Erythrophlein, the only alkaloid of this series. Extracted from bark of 
Erythrophlceum Guineense. 

Epinephrin from suprarenal extract. 

Bufonin and Bufotalin from toads' skins. 



Il6 CONSTITUTIONAL ORGANIC DRUGS. 

GROUP OF QUININE. 

The group is composed of QUININE and other alkaloids ex- 
tracted from the Cinchona bark. The characteristic action of its 
members is a decrease of the functional activity of all forms of proto- 
plasm; the poisonous action being greater, the lower the scale of 
the protoplasm. On account of this selective action for lower 
organism, enough quinine may be given to a highly organized 
individual, such as man, which will not impair his vital functions 
but will attack a unicellular parasite in his blood, as the malarial 
protozoon. It is upon this fact that the greatest specific use of 
quinine in the treatment of malaria is based. 

When fresh water amoebae or infusoria are treated with a very 
weak solution of quinine, there is first, an exceedingly transient 
increase in their movements, followed rapidly by a decrease and 
complete arrest with granular degeneration of the protoplasm. 
When more quinine is used, the arrest of the movements and the 
granulation is immediate. A similar effect has also been ob- 
served upon leucocytes and upon the protozoa of malaria. 

On account of the decrease in the movements of leucocytes, 
their passage through the walls of the blood vessels and the 
formation of inflammatory exudates may be checked. The 
number of leucocytes in the blood is also decreased. The spleen 
is diminished in size when pathologically enlarged in malarial 
fever. 

In frogs, quinine produces, besides a condition of narcosis, 
some increased reflexes due to a preliminary stimulation of the 
cord. This is, however, followed by general paralysis of the 
whole central nervous system. This effect is not remarkable 
as it is usual with most protoplasmic destroyers, before the de- 
crease in the functional activity and death of the tissues, that 
there should be a preceding stage of increased irritability. Also 
in the muscles of the frog there is to be observed, at first, an 
increased power of contraction and capacity for work but rapid 
tiring. The heart muscle never shows increased activity, but 
from the first, a decrease in force and ultimately complete arrest. 



GROUP OF QUININE. 117 

Corresponding to the destruction of the lower forms, there 
occurs a decrease in the metabolism of warm-blooded animals. 
The nitrogenous end products in the urine are diminished and 
the formation of heat is lessened. As a sequel of this action on 
metabolism, a febrile temperature may be lowered. 

On account of its general action on protoplasm, quinine is a 
local irritant. When injected subcutaneously much pain is 
felt and sloughing occasionally occurs. Given by the mouth, 
it produces in small quantity, an increase in appetite and in the 
secretion of digestive juices, while in larger quantities, irritation 
and inflammation of the gastro-intestinal tract, with decreased 
appetite, nausea, vomiting and sometimes diarrhoea. 

The highly organized protoplasm of the central nervous 
system of mammals is less affected than that of the lower forms. 
Yet in sufficient quantities the same depressant effect is to be ob- 
served. Sensation and consciousness are decreased and death is 
produced by paralysis of the respiratory centre and of the heart. 

The rate of the heart beat is at first increased, probably 
through central depression of the vagus. In consequence of the 
increase in rate the blood pressure may be slightly raised. The 
cardiac muscles are soon affected, when both the rate and force 
of the circulation are decreased and the blood pressure falls, 
until the heart stops entirely. 

Quinine in the form of the hydrochloride of quinine and urea 
produces marked local anaesthetic action similar to cocain. 
Even in strength of only % to % per cent., the anaesthesia is 
more complete than with cocain and lasts much longer — even up 
to four to five days after subcutaneous injection. A fibrinous 
exudate is formed at the site of injection which, however, is not 
marked with low concentrations. 

Quinine is rapidly excreted by the kidneys, partly as such, 
and partly as an oxidation product. 

When this drug is given in large doses to an ordinary individual, 
or in moderate doses to a very susceptible human being, various 
symptoms called untoward effects occur. Among these are 
headaches, fullness in the head, dizziness, roaring in the ears, 



Il8 CONSTITUTIONAL ORGANIC DRUGS. 

disturbances of vision with partial or complete blindness, deaf- 
ness, dulling of consciousness, sleepiness and even coma. These 
symptoms usually subside after the withdrawal of the drug, al- 
though blindness and deafness have lasted over quite a period of 
time. The aural disturbances are said to be due to congestion 
of the middle ear, while those of the eye are attributed to anaemia 
of the retina. Other symptoms, probably due to the irritant 
effect of quinine, are gastro-intestinal inflammation, skin erup- 
tions and irritation of the kidneys. Bleeding from the latter and 
other mucous membranes may also occur. Abortion, which is 
said to have been seen after quinine, is probably due to both 
irritation of the gastro-intestinal tract and also to a stimulant 
action on the smooth muscles of the uterus, corresponding to the 
muscular stimulation observed in frogs. 

The other alkaloids of cinchona possess an action closely 
resembling that of quinine, except that they have some tendency 
to produce increased reflex irritability and convulsions. They 
are all weaker, except cinchonidine. 

SUMMARY OF GROUP ACTION.— Protoplasmic poison 
causing arrest of movements, granular degeneration and death of 
lower forms. Specific poison to Plasmodium of malaria. De- 
pressant to movements of leucocytes, thus stops inflammatory exu- 
dates. Untoward effects on ears and eyes causing roaring in the 
ear, partial blindness and deafness, also skin eruption, gastro-in- 
testinal disturbance and irritation of kidneys. Depressant to 
central nervous system and heart. 

THERAPEUTIC APPLICATION.— The main use of quinine 
is as a specific in the treatment of malarial fever. Its action is 
more marked on the young forms and in order to affect these most 
powerfully, it is usually administered in large doses a few hours 
before the division of the parasite which is coincident with the 
chill. Thus the blood is made to contain a maximum amount of 
the drug at the time of division. It is also employed as a pre- 
ventative of malaria in districts where it is prevalent, but for this 
purpose only small doses are necessary. 

It is used in the form of rectal injections in amoebic dysen- 



GROUP OF QUININE. II9 

tery, with the hope that it may destroy the protozoa of this affec- 
tion as it does those of malaria. 

Quinine is used as an antipyretic in febrile diseases other than 
malaria, such as typhoid fever, typhus, pneumonia, tuberculosis 
and septicaemia, but its antipyretic action in such conditions is not 
as powerful as that of the coal tar preparations, which have, in 
great measure, replaced it. 

It has been used as an analgesic in neuralgia and headache. 
When these conditions are not of malarial origin, its good effects, 
if any, may be explained by the depressant action upon the cen- 
tral nervous system. 

It is also employed in wasting diseases and convalescence from 
acute affections, as an appetizer because of its bitter taste, and as a 
gastro-intestinal stimulant to increase the digestion and absorption 
of food. For the last indication, the crude preparations of cin- 
chona are usually administered before meals in an alcoholic 
beverage. 

As a local anaesthetic, quinine and urea hydrochloride has 
risen in importance. It is usually injected in the strength of 
% to 1 per cent, and applied to the mucous membrane in that of 
10 per cent, to 20 per cent. 

MATERIA MEDICA. 

Cinchona (U.S. P.), bark of Cinchona Calisaya and other hybrid species, 
Cinchonas Rubrae Cortex (B.P.), bark of Cinchona Succirubra. The Cin- 
chonas grow in South America, India and Malay Isles. They contain in the 
native 1 per cent., in the cultivated 5 per cent, alkaloids. About half of 
this is quinine. The balance is composed of a variety of closely alhed bodies, 
of which the principals are quinidine, cinchonine and cinchonidine. 

Tinctura Cinchonse (U.S.P.,B.P.). Dose:— 0.5 c.c. Br. (>£-i fl.5). 
Average (U.S. P.), 4.0 c.c. 

Tinctura Cinchonae Composita (U.S.P.,B.P.). Dose: — 4.0-15.0 c.c. 
Br. (}4-i fl.5). Average (U.S.P.), 4.0 c.c. 

Vinum Quininae (B.P.). Dose: — 15.0-30.0 c.c. Br. (J^-i fl.5)- 

Quinina (U.S. P.), a white, crystalline alkaloid, soluble in 1750 parts H 2 
and in 0.6 part of alcohol. It forms crystallizable salts with an intensely 
bitter taste. The most commonly used are the sulphate, bisulphate and 
hydrochlorate. When given subcutaneously or intravenously, the last two 
are preferred on account of their greater solubility. 

Dose of Quinine and all its salts 0.2-1.0 G.; Br. (1-10 grains). Average 
(U.S. P.), 0.25 G. For malaria usually given in the dose of 1.0 G. about two 
hours before the expected chill and a few tenths at intervals during the 



120 CONSTITUTIONAL ORGANIC DRUGS. 

balance of the time. For amcebic dysentery given in the form of high 
enemata containing o.i per cent, quinine. 

Quininae Sulphas (U.S.P.,B.P.), soluble in 720 parts H 2 and 86 parts of 
alcohol. Contains 74 per cent, quinine. 

Quininae Bisulphas (U.S.P.), soluble in 8J4 parts H 2 and 18 parts of 
alcohol. Contains 60 per cent, of quinine. 

Quininae Hydrochloridum (B.P.), soluble in 18 parts H 2 and 0.6 part 
alcohol. 

Quininae et Urea Hydrochloridum, soluble in about 1 part of H 2 0. 
Suitable for subcutaneous injection, as a local anaesthetic in solutions of }i 
to 10%^ 

Euquinine, ethylester of quinine, said to possess therapeutic virtues of 
quinine without bitter taste. Dose same as quinine. 

Aristoquinine, another artificial derivative of quinine, white, tasteless 
powder. Dose same as quinine. 



GROUP OF ACETANILID AND PHENOL. 

This group comprises chiefly bodies extracted from coal tar, 
their derivatives and synthetic products, besides certain sub- 
stances obtained from wood tar and also some natural deposits 
having a resemblance to the first in composition and action. 

The use of members of this series to reduce fever temperature 
dates back to the introduction of salicylic acid in 1875. This 
was followed by carbolic acid, resorcin, and various quinolin de- 
rivatives, which were discovered in an attempt to synthetize 
quinine. Each year, large numbers of synthetic compounds were 
made, with the aim at first of making quinine artificially, later 
of forming compounds which had the advantage of those already 
formed without their disadvantages. 

All the members of this group have, in a general way, the same 
action as quinine. This is a depressant one on the lower forms 
of protoplasm and, therefore, they are antiseptics, although they 
do not have a specific action upon the malarial Plasmodium. 

•They decrease the body temperature in fevers. This is due 
partly to diminished heat production, partly to increased heat 
dissipation brought about by a dilatation of the superficial 
blood vessels. On the contrary, the internal vessels are not di- 
lated, so that there is not at first a fall of blood pressure, and in 
some cases there may even be a rise. 



GROUP OF ACETANILID AND PHENOL. 121 

They all depress the central nervous system, especially at first, 
the parts associated with the sensation of pain. Later, the entire 
central nervous system is paralyzed producing unconsciousness, 
collapse and death due mainly to paralysis of the respiratory 
centre in the medulla. With many members of this group, there 
has been observed in animals a stage of increased irritability, 
which may lead to convulsions. 

The heart's action may, at first, be increased in rhythm, 
but later it is decreased in both rate and force. The antipy- 
retics often produce in large doses methaemoglobinaemia. 
They also give rise to local irritation which, after internal 
administration, may lead to vomiting, diarrhoea and gastroen- 
teritis, acute or chronic. This irritant action also occurs in the 
kidneys, where they are excreted partly changed. 

The untoward effects which are sometimes observed are 
excessive sweating, skin eruptions, chills, digestive troubles, irri- 
tation of the kidneys, buzzing in the ears, disturbances of vision, 
cyanosis and collapse. The latter may even occur after very 
small doses of some of these substances. 

According to the action of the members of this group they 
are indicated in therapeutics for three different purposes, firstly, 
as antipyretics, i. e., to lower febrile temperature; secondly, as 
analgesics to decrease pain; thirdly, as antiseptics. Some are 
used for one of these purposes, others for all three. 

The different members of this large group vary enormously 
in toxicity as may be judged by the comparative dose of car- 
bolic acid, o.oi gramme and benzoic acid i.o gramme, i.e., one 
hundred times greater than the other. Regardless of the de- 
gree of toxicity, but making a purely arbitrary division based 
on the chief usage, the group is again subdivided into the Ace- 
tanilid Division used mainly to reduce febrile temperature and 
quiet nervous pains and the Phenol Division whose members 
are chiefly employed at the present time as antiseptics and dis- 
infectants in different parts of the body. It is, however, to 
be remembered that the divisions are not at all sharp, that 
members of one frequently pass into the other. 



122 CONSTITUTIONAL ORGANIC DRUGS. 

ACETANILID DIVISION. 

In this subdivision are described Acetanilid, Antipyrine, 
Salicylic Acid and other substances related to these. 

ACETANILID, when administered by the stomach to dogs in 
doses of 0.5 gramme per kilo of body weight, produces som- 
nolence and sleep, but when injected in this quantity into the 
blood-stream it causes convulsions and death due to paralysis of 
respiration. The heart does not suffer as much as the respiratory 
system. 

Doses of a few grammes given to a normal man produce some 
pain in the stomach, sleepiness with occasional headaches, 
cyanosis and profuse sweating but little or no decrease of tem- 
perature, and at times even a slight elevation. 

When given to febrile patients in even much smaller doses, 
the temperature rapidly decreases and all the attendant symp- 
toms and distress of fever diminish or disappear; but in the 
course of a few hours, if a new dose is not given, it rises again. 
The rate of the pulse is lowered by the lowering of the tem- 
perature, as it rises again as soon as the latter becomes once 
more elevated. 

Although in many cases no other symptoms but a fall of tem- 
perature and pulse and an increase in comfort occurs, yet in a 
certain percentage of patients, one or all of a train of symp- 
toms may arise, so-called untoward effects. These consist of 
severe chills with clashing of teeth, profuse and exhausting 
sweats, nausea and vomiting, skin eruptions and cyanoses and 
in severer cases alarming collapse which has even resulted in 
death. Besides, there may occur certain brain symptoms as 
fullness in the head, headaches and roaring in the ears. 

Occasionally acetanilid has been used, either with or without 
doctors' advice, as a dusting powder over chronic ulcers, especially 
of the varicose variety. In consequence of the long continued 
external application or of the internal ingestion in the form of 
"patent headache powders," there have been observed many 
cases of chronic poisoning and habit. In these cases the 



GROUP OF ACETANILID AND PHENOL. 1 23 

patients complain that when they do not dust it on their ulcer, 
or in the other cases if they do not take the " powder," that they 
are uncomfortable, have headaches and general distress. Such 
patients have loss of appetite, gastro-intestinal disturbances, 
often marked anaemia, great general debility with special weak- 
ness of the heart, and more or less cyanotic appearance, especially 
of the lips and face. The cyanosis is due in part to changes in the 
blood coloring matter as it is to a certain extent transformed to 
methaemoglobin. The destruction of the red blood corpuscles 
which occurs produces the anaemia. 

The nitrogenous metabolism as may be judged by the 
nitrogen in the urine is increased by small doses but is decreased 
by large ones. It might be inferred that larger doses by a de- 
pressing action on protoplasm lessen tissue changes. 

The decrease of temperature in fever is probably effected chiefly 
through the action of acetanilid upon the heat regulating centres by 
narcotizing the same, thus preventing the stimulation from the 
toxins present in different febrile diseases. A considerable loss 
of temperature occurs from the dilatation of the superficial ves- 
sels of the skin while all the deeper ones remain contracted, 
with the blood pressure as high if not higher than before. Thus 
much blood is brought to the surface of the body and cooled. 

Acetanilid does not decrease the phagocytic activity of the 
leucocytes nor does it decrease the production of antitoxin in 
an infectious disease. Its antiseptic action is not very powerful, 
requiring a strength of 2 to 5 per cent, and having no specific 
effect on the malarial parasite. 

Excretion is rather rapid and takes place after partial oxida- 
tion through the kidneys which may at times show marked irri- 
tation. 

Other aniline derivatives as Phenacetine, Lactophenin, 
Methacetine, Exalgine and Benzanilid have practically the 
same action as acetanilid. They are said to produce less often 
untoward symptoms, and Phenacetine and Lactophenin are 
reputed with more analgesic effect in neuralgic affections. The 
mother substance of all these, Aniline, is a very poisonous 



124 CONSTITUTIONAL ORGANIC DRUGS. 

product not used in medicine. It causes, in small doses, convul- 
sions, cyanosis, vomiting and fatal collapse. 

ANTIPYRIN is less poisonous than acetanilid, but its action is 
otherwise very much the same. It causes in animals the same 
decrease of consciousness, convulsions and collapse. In practice, 
however, it produces less frequently the different untoward effects 
and it does not attack the red blood corpuscles or change the 
haemoglobin to methaemoglobin. 

When applied locally to a mucous membrane, it contracts the 
blood vessels just like adrenaline, therefore the part becomes 
white and anaemic. If there is any hemorrhage, it arrests the 
same. In the nose it shrinks up the turbinate bodies thus 
allowing a better field for manipulations. It makes operations 
upon the eye, nose and throat less bloody, and also produces a 
considerable amount of local ancesthesia. 

Some more phenylhydrazine derivatives are Salipyrine, 
Resopyrine, Pyramidon, Pyrodine and Antithermin. The 
first two act very much like antipyrin but the last three, Pyrodine, 
Antithermin and Pyramidon, are much more toxic and should 
be used only with great caution. Phenylhydrazine itself is a 
very poisonous substance producing a brown coloration of the 
blood due to methaemoglobin formation and also to a colored 
product of this drug. It causes severe depression of the central 
nervous system and death with convulsions. 

Among the first antipyretics introduced in medicine were 
QUINOLINE and three of its derivatives Kairin, Kairolin and 
Thalline. Quinoline was introduced because it is present in the 
quinine molecule which has such wonderful effects on intermit- 
tent fever. Soon its use had to be discontinued as it produces 
so often and easily collapse. In small doses in animals, it causes 
sleepiness and loss of sensation, but larger quantities produce 
death from paralysis of the medulla. Kairin, kairolin and thalline 
were much less poisonous, yet their use has now been discontinued. 
More recently two new derivatives of quinoline, Analgen and 
Thermifugine, which are not very poisonous, have been intro- 
duced in practice. 



GROUP OF ACETAXILID AND PHENOL. 1 25 

SALICYLIC ACID and its simple salts such as Sodium Salicylate, 
have practically the same general action as acetanilid only less 
powerful. They are less apt to produce the disagreeable un- 
toward symptoms but require much larger doses for antipyretic 
and analgesic effect. 

Salicylic acid is a little stronger antiseptic than acetanilid. 
In sufficient concentration it stops ferment action; thus it arrests 
gastric and pancreatic digestion and stops the fermentation 
of sugar and alcohol. It also stops the movements of protozoa 
and leucocytes, like quinine, although it is not as powerful as the 
latter and does not act specifically in malaria. When applied 
to the skin in the form of very concentrated solutions or oint- 
ments, it softens and removes the horny layers of the epidermis 
but does not attack the deeper ones. In solid form, taken 
internally, it may produce reddening and superficial corrosion 
of the mucous membranes of the gastrointestinal tract, but these 
effects are never to be seen from diluted solutions or from the 
salts. 

Salicylates increase the nitrogenous metabolism to the 
extent of ten to twenty per cent, after moderate doses. After 
large poisonous quantities, it may be decreased, as after acetani- 
lid. The increase in the nitrogen output is not alone in the form 
of urea but also of uric acid, which may show an augmentation of 
nearly fifty per cent. Corresponding to this increased uric acid 
excretion, there is a marked leucocytosis in the blood. 

The diminution of febrile temperature is less than with 
antipyrin, but it requires much larger doses of salicylic acid to 
produce toxic symptoms in animals. These consist of vomiting, 
somnolence, at first increased pulse and respiration, but later 
decrease in both, convulsive respirations, convulsions, paralysis, 
especially of the hind legs and death in collapse. With small 
doses the superficial blood vessels alone are 'dilated and the blood 
pressure is raised just as with acetanilid. 

The untoward effects which occasionally occur in man con- 
sist of profuse sweating, chills, buzzing in the ears, partial or com- 



126 CONSTITUTIONAL ORGANIC DRUGS. 

plete deafness, dimness of vision, skin eruptions, vomiting, headache 
and dizziness. 

The salicylates are excreted chiefly by the kidneys, partly as 
such, and partly changed to salicyluric acid, a compound with 
glycocoll. In passing through these organs, they may produce, 
with small doses, and on account of their irritant action, increase 
in the flow of urine, but with large doses and weak kidneys, 
albuminuria, hematuria, and even acute Bright's disease. 

There is a small amount of salicylic acid excreted by the milk, 
perspiration, synovial secretion of joints and bile. The excretion 
by the sweat may explain the skin eruptions, while that by the 
joints the good effects observed in acute rheumatism, and that 
by the liver, the stimulation of this organ and the increased flow 
of both the solid and fluid constituents of bile. 

Increased bleeding at the menstrual period and occasionally 
abortions have followed the salicylate treatment, also hemor- 
rhages from other organs, such as the gums and nose, have been 
observed. 

Recently, different products of salicylic acid have been made 
artificially. These are insoluble in water and are therefore 
insoluble in the stomach and less irritating to this organ, but 
they are dissolved or decomposed by the alkaline pancreatic 
juice. They may then become absorbed and produce the same 
general action as the mother substance. In the case of one of 
these bodies, SALOL, it is decomposed into salicylic and carbolic 
acid so that it has the action of both substances. Other similar 
derivatives which do not give off free phenol are Salophen, 
Aspirin, Novaspirin, Salocoll, Malakin and Salocreol. 
Plant life gives us two bodies of this group, Methyl Salicylate or 
oil of wintergreen, and the glucoside Salicin, which is decom- 
posed into salicylic alcohol; both of these have the characteristic 
action of this division. Oil of wintergreen is more irritant 
locally than salicylic acid because it possesses in addition to its 
characteristic action, the irritant effect of all volatile oils. 



GROUP OF ACETAXILID AXD PHEXOL. 1 27 



PHENOL DIVISION. 

This subdivision contains the members of the group which 
are used in clinical medicine nowadays almost exclusively for 
antiseptic purposes. It consists of different phenols, as Carbolic 
Acid and Thymol. Creosote, Naphthalene and its derivatives, 
Benzoic Acid and Ichthyol. 

PHENOL. — The general protoplasmic effect seen from most 
of the members of the coal tar group, is especially well marked 
with phenol or carbolic acid. The latter stops the movements 
of protozoa and leucocytes, arrests the development and even 
kills the lower plant forms, as bacteria. Like most of the other 
protoplasmic poisons it shows a much greater toxic action on 
the lower animal cells as protozoa and spermatozoa, etc.. than on 
the bacteria. Its degree of antiseptic action varies enormously 
with different organisms; for instance, the ordinary pus cocci are 
killed by a low concentration, while anthrax spores and tubercle 
bacilli require a long exposure of a five per cent, solution for any 
effect at aU. 

Phenol precipitates the proteids both in solution and in animal 
tissues. If applied to the skin in concentrated form, it at first 
burns, but this sensation soon passes away with paralysis of 
the sensory nerve endings and the skin becomes anesthetic and 
turns white due to the precipitated albumen of the ceUs. In a 
few days the scab falls off and the brown stain remains for a little 
while. On account of this precipitation of albumen the caustic 
effect as a rule remains limited to the upper layers if the appli- 
cation has been of short duration. On the contrary, when phenol 
has remained in contact with tissues for a few days, as has 
happened after the use of concentrated carbolic acid poultice 
on a finger, deep protoplasmic necrosis and gangrene of the 
member may be observed. Local anaesthesia and allay of itching 
may take place from very diluted solutions which have no corro- 
sive effects, so that this action is a direct one on the sensory nerve 
endings. 

When a very large dose of carbolic acid is taken by a man, he 



128 CONSTITUTIONAL ORGANIC DRUGS. 

may, as after hydrocyanic acid, drop to the ground unconscious 
and die within a few minutes from paralysis of the vital functions 
without any convulsions or other symptoms, for the toxic effect 
on the central nervous system and heart is very great. With smaller 
doses, a train of symptoms is to be observed, which consist of 
nausea, vomiting, great weakness, headache, dizziness, somno- 
lence, disturbance of the intellect, muscular twitching and con- 
vulsions, great weakness of the heart and dyspnceic respirations 
and at last death in collapse. There is usually marked sweating, 
salivation and increased bronchial secretion. The latter may give 
rise to a cough. 

A form of general poisoning, not infrequently results from 
absorption by the skin or wounds when applied as a remedy. 
It takes the form of great general weakness, headaches and 
somnolence, very weak pulse, sometimes oedema, diminution 
in the secretion of urine, and a dark brown or black color of this 
secretion, which may also contain albumin and blood. 

In frogs, there is to be seen at first, general depression of move- 
ments, then muscular twitchings, strychnine-like convulsions and 
lastly general paralysis. In warm-blooded animals, the heart 
and respiration show a slight increase at first, then both func- 
tions are decreased, the heart muscle being directly paralyzed, 
likewise the respiratory centre. 

The red blood corpuscles are to a certain extent destroyed, 
but there is no transformation of haemoglobin to methaemoglobin 
except outside the body. The central nervous system shows the 
same change as from acetanilid only much more strikingly. It 
consists of a general paralysis preceded by stimulation of certain 
areas, especially those producing convulsions. Its action on the 
metabolism and febrile temperature is of the same order and, 
in fact, it was used formerly as an antipyretic. 

In its passage through the body, phenol at first combines with 
glycuronic and sulphonic acids and the resulting compounds 
are much less toxic. When these are exhausted, it then cir- 
culates as such and by oxidation yields hydroquinon and pyro- 
catechin. All of these are excreted by the urine, and the last 



GROUP OF ACETANILID AND PHENOL. 1 29 

two impart to this secretion the dark brown or black color seen 
in cases of poisoning. The color always intensifies by exposure 
to the air because of further oxidation. The kidneys as a rule 
suffer from more or less irritation, and at times a true nephritis 
with albumen, blood and casts is produced. After prolonged 
administration, fatty degeneration of liver cells has been observed 
and corresponds to the protoplasmic poisonous action. 

PYROGALLOL or pyrogallic acid, a trioxybenzol, produces 
practically the same symptoms as phenol, only in a much stronger 
degree and, in addition, destroys the red blood corpuscles and 
changes the hcemoglobin to methcemoglobin. It also produces de- 
structive changes in the liver and kidneys. It is so poisonous that it 
is even dangerous in extensive, external application to the skin. It 
colors the latter a deep brown, a stain which can be removed 
by benzine. 

RESORCINE, another phenol, dioxybenzol, acts on warm- 
blooded animals very much like carbolic acid but less powerfully. 
It is, however, even more strongly antiseptic. It is excreted in 
the urine in the same way. 

CREOLIN contains different cresols and is supposed to be less 
poisonous than carbolic acid, but of the three cresols, metacresol 
is the only one which is less poisonous, the para- and orthocresols 
being more toxic than carbolic. All have in general the same ac- 
tion, and external application of creolin has resulted in the same 
poisoning as from the group type. There is a saponified solution 
of creolin, called lysol, with identical action. 

THYMOL, another phenol, acts like the latter but being very 
insoluble in water, does not become absorbed readily, therefore 
is much less toxic to warm-blooded animals. Its antiseptic 
powers are considerably greater and it has especially well-marked 
effects upon intestinal parasites, more particularly the "hook 
worm." In chronic poisoning it causes degeneration of the 
protoplasm of parenchymatous organs like phenol. It is ex- 
creted by the urine conjugated with sulphonic and glycuronic acid 
and is very apt to irritate the kidneys. 

CREOSOTE is a mixture of phenols obtained from wood tar. 
9 



130 CONSTITUTIONAL ORGANIC DRUGS. 

It has as strong antiseptic action, but is less toxic to warm-blooded 
animals than carbolic acid. 

NAPHTHOLS, when injected in large doses into animals, pro- 
duce practically the same symptoms as the phenols, yet they are 
less apt to give rise to convulsions. They are much stronger ger- 
micides. Given in smaller doses over a period of time, they 
produce diarrhoea, with severe irritation and degeneration of 
the kidneys, leading to nephritis. Another great characteristic 
symptom, is a form of degeneration of the retina, optic nerve and 
lens. Plaques of opacity are seen in the retina and lens. These 
symptoms may be also observed in man. The naphthols become 
excreted in the urine combined with glycuronic and sulphonic 
acid. Naphthalene is easily oxidized in the body to naphthols 
and acts like the latter. 

BENZOIC ACID possesses the general action of this subdivi- 
sion only the poisonous symptoms are elicited with immensely 
larger doses than with carbolic acid. Its irritant action, and that 
of its salts, is especially well marked, being very prone to produce 
nausea and vomiting. It augments the nitrogen excretion 
like salicylic acid, but contrary to the latter, decreases the excre- 
tion of uric acid. Benzoic acid is excreted, partly as such, partly 
combined with glycocoll in the form of hippuric acid, by the urine 
where it acts as an antiseptic and irritant. Small amounts 
have also been found in the saliva of dogs. 

TAR contains different antiseptic members of this division 
and has a weak but similar effect on the organism. 

ICHTHYOL, a tarry product of fossil fishes, contains also differ- 
ent antiseptic compounds and in a very mild degree has some 
of the action of this group. 

SUMMARY OF GROUP ACTION.— Contained in the first 
pages of Group of Acetanilid and Phenol. 

^THERAPEUTIC APPLICATION.— Members of the acetani- 
lid subdivision are used chiefly to reduce febrile temperature in 
different fevers other than malaria. In the latter, although they 
may decrease the temperature, they do not exercise a specific 
action on the malarial parasite. 



GROUP OF ACETANILID AND PHENOL. 131 

The decrease of febrile temperature is sought, either when the 
latter becomes dangerously high or when there is marked dis- 
comfort from it. The drugs of this group are usually given in 
small doses every three or four hours when the fever is high. 
The difference of influence on different fevers varies a little; for 
instance, they depress less markedly fevers from septic infection 
and pneumonia. They are very active in typhoid fever, in the 
eruptive diseases as scarlet fever, measles and in certain febrile 
cases of tuberculosis. 

On account of their depressant effect on the sensory side of the 
central nervous system they are employed to check headaches and 
neuralgic pains. Some, such as salicylic acid and its compounds, 
are used in the treatment of acute rheumatism. The effect may 
be antiseptic on the affected joints or the improvement may be 
due to the antipyretic and analgesic actions combined. It does 
not seem that the course of the disease or that the frequency 
of complication is at all shortened. Salicylic acid and some of its 
compounds have been used externally in the form of ointments as 
antiseptics and irritants in different skin diseases and also internally 
as disinfectants of the gastro-intestinal tracts. 

The members of the carbolic acid group are also -used both 
internally and externally as antiseptics. The different skin diseases 
make the chief field for all these substances applied in the form 
of washes, ointments, collodia, etc. Carbolic acid, creolin and 
lysol are used very extensively for washing wounds and surgeons' 
hands. Thymol has found its chief field of usefulness in the 
treatment of the hookworm disease, and benzoic acid as a 
urinary antiseptic. 

MATERIA MEDICA. 
(A) Aniline Derivatives. 

Aniline, amido-benzol, is not used in medicine because of its great ten- 
dency to produce collapse. 

Acetanilidum (U.S.P.,B.P.) (antifebrine), white, almost tasteless crystals, 
permanent in air, soluble in about 180 parts water, soluble in alcohol, ether 
and chloroform. Best administered, as a powder. It produces a fall of 
temperature one hour after administration which may last for 12 hours. 
Used to decrease temperature in infectious fevers, as typhoid, measles, 
scarlatina, acute articular rheumatism and tuberculosis. As an analgesic it 



132 CONSTITUTIONAL ORGANIC DRUGS. 

is used in tabes dorsalis, neuralgia, migrain and headaches. As an anti- 
septic it is sometimes dusted on ulcers and wounds. Dose: — 0.2-0.5, U P 
to 4.0 G. in 24 hours. Br. (1-3 grains). Average (U.S. P.) 0.25 G. 

Exalgine (methyl antifebrine), white, crystalline body, slightly soluble in 
water, soluble in alcohol, ether and chloroform. Same uses as acetanilid. 
Dose : — 0.2-0.5 G. up to 4.0 G. in 24 hours. 

Antisepsine (para-brom-acetanilid) , colorless crystals, soluble in alcohol, 
insoluble in water. Used externally as an antiseptic in the form of dusting 
powder and salve. 

Acetphenetidinum (U.S.P.), Phenacetinum (B.P.), colorless, odorless, 
tasteless crystals, almost insoluble in water, soluble in alcohol. It has the 
same uses as acetanilid, but it is a more efficacious analgesic. Dose : — 0.2- 
0.5 G. Average (U.S.P.) 0.5 G. 

Methacetine contains one less methyl group than phenacetine. It is 
more easily soluble in water and is used in the same doses and for the same 
indications. 

Benzanilid resembles phenacetine and is used in small doses for children. 
Same dose as the above. 

Lactophenyl resembles phenacetine in properties, action and uses. 
Same dose as the above. 

(B) Antipyrine Series. 

Antipyrina (U.S.P.), Phenozonum (B.P.), white crystals without odor, 
with slightly bitter taste, freely soluble in water, alcohol and chloroform. 
Used locally to relieve congestion and stop hemorrhage during operative 
procedures upon the nose, throat and eye and internally as an antipyretic 
and analgesic. Rather smaller doses can be used for analgesic purposes. 
Dose: — 0.5-1.0 G. up to 8.0 G. in 24 hours. Br. (5-20 grains). Average 
(U.S.P.) 0.5. 

Salipyrine, compound of salicylic acid and antipyrine, white powder 
soluble in about 200 parts water, very soluble in alcohol and chloroform. 
Same action and uses as antipyrine. 

Resopyrine, compound of resorcine and antipyrine. Same action and 
uses as antipyrine. Dose: — 0.5-1.0 G. 

Pyrodine (acetyl phenyl hydrazine), colorless crystals, soluble in alcohol, 
much more poisonous than antipyrine. Dose : — 0.01-0.06 G. 

Antithermine (phenyl hydrazine levulinic acid), also more dangerous 
than antipyrine. 

Pyramidon (dimethyl amido antipyrine), white tasteless powder soluble 
in water. Same uses as antipyrine. Dose : — 0.2-0.5 G. 

(C) Quinoline Series. 

Quinoline, colorless liquid which smells like tobacco, soluble in water. 
It acts as a base, and therefore forms salts with acid. Its salts were used 
internally as antipyretics, but were afterwards discarded because of their 
danger. Now it is sometimes used as a disinfectant gargle for diseases of the 
throat in the strength of 1-500%. 

Kairin, Kairolin and . Thalline, are quinoline derivatives which were 
formerly extensively used as antipyretics. Dose: — 0.1-0.2 G. 

Analgen, a recent quinoline derivative composed of white crystals, in- 



GROUP OF ACETANILID AND PHENOL. 1 33 

soluble in water, soluble in alcohol. Used in fevers, neuralgias and head- 
aches. Dose: — 0.5-1.0 G. 

Crurin Purum (quinoline bismuth sulphocyanate) , fine, reddish, crystal- 
line powder, insoluble in water, used externally as a dusting powder over 
wounds. 

Chinosol (oxyquinoline sulphonate of potassium). Yellow crystals with 
astringent taste and saffron odor, easily soluble in water but insoluble in 
alcohol. Strong antiseptic and hemostatic. Used internally for tubercu- 
losis and externally as disinfectant in solution of 1-1000, also in 5-10 per 
cent, in ointment and as dusting powder. Dose : — 1.0 G. daily. 

(D) Salicylic Acid Series. 

Acidum Salicylicum (U.S. P., B.P.), white crystalline body, soluble in 
about 300 parts water. Dose : — 1 .0 up to 4.0 G. per day. Br. (5-30 grains) . 
Average (U.S.P.) 0.5 G. 

Sodii Salicylas (U.S.P.,B.P.), white crystals odorless with a sweetish 
taste, soluble in about 1 part of water. Solutions turn red on standing. 
Dose: — 1.0 up to 15.0 G. per day. Br. (10-30 grains). Average (U.S.P.) 
1.0G. 

Lithii Salicylas (U.S.P.), deliquescent white crystals, very soluble in 
water. Dose: — 1.0 up to 15.0 G. per day. Average (U.S.P.) 1.0 G. 

Oleum Gaultheriae (U.S.P.), oil of wintergreen, yellowish fluid with 
characteristic odor and taste. Soluble in alcohol, insoluble in water. Com- 
posed of 90 per cent, methyl salicylate. Dose: — 0.3-1.0 c.c. Average 
(U.S.P.) 1.0 c.c. 

Spiritus Gaultheriae (U.S.P.), 5 per cent, alcoholic solution of the oil. 
Dose : — 1.0 to 6.0 c.c. Average (U.S.P.) 2.0 c.c. 

Salicinum (U.S.P., B.P.), glucoside found in willows and poplars. It 
is composed of white crystals with a bitter taste, soluble in 21 parts of water, 
decomposed by a ferment into salicyl alcohol and glucose. Dose: — 0.5 to 
2.0 G. Br. (5-30 grains). Average (U.S.P.) 1.0 G. 

Phenylis Salicylas (U.S.P.), or Salol, white crystals, aromatic odor, 
almost tasteless, insoluble in water. Decomposed by alkaline fluids of the 
intestines into phenol and salicylic acid. 

It has no action on the stomach because it remains insoluble in acid juices 
and so it can be used to coat pills destined for intestinal action. In the in- 
testines, it acts like its constituents as an antiseptic, and after absorption, as 
an antipyretic. It is used as an internal antiseptic in inflammatory conditions 
of the intestines. It is also employed as an antipyretic in feverish conditions 
such as colds, influenza and rheumatism. It is used for diagnostic purposes 
to determine the motor efficiency of the stomach, for when salicyluric acid 
appears in the urine it is an indication that the salol has passed from the 
stomach into the intestines. Dose: — 0.5-2.0 G. Br. (5-30 grains). 
Average (U.S.P.) 0.5 G. 

Salophen (acetyl-amido-phenol salicylic acid), has the same action and 
uses as salol, but it is less poisonous because instead of free phenol the non- 
poisonous acetyl-amido-phenol is liberated in the intestines. Dose: — 0.3 
to 1.0 G. 

Salocoll (phenocoll salicylate), is also split in the small intestines into 
salicylic acid. Same dose and uses as salol. 

Malakin. — Another compound similar to salol. Same dose and uses. 



134 CONSTITUTIONAL ORGANIC DRUGS. 

Aspirin, acetyl salicylic acid, almost entirely insoluble in water and only 
dissolved in the intestines, where it is split into salicylic acid. Dose: — 
1.0-2.0 G. 

Mesotan (methoxymethylester of salicylic acid), greenish liquid almost 
odorless, and easily absorbed by the skin. Used in articular rheumatism 
rubbed into the skin in 5 c.c. doses. 

Salicylic acid and its derivatives are used internally and externally as anti- 
septics, internally, as antipyretics and analgesics, especially in acute articular 
rheumatism, the salicylates are given in gramme doses every hour until the pain 
and fever are relieved, or until poisonous or untoward symptoms arise. 

The preparations of salicylic acid should not be administered after buzzing 
in the ears ensues. They should not be given to menstruating women, as they 
may increase the hemorrhage from the uterus. 

(E) Phenol Series. 

Phenol (U.S. P.), Acidum Carbolicum (B.P.), colorless, deliquescent 
crystals, which become pink on standing and melt at 40 C, very volatile 
and liquefy when mixed with five parts of water. Soluble in water enough to 
make a 5 per cent, solution. It is used nowadays as an internal antiseptic 
in pill form, but was formerly employed as a febrifuge. Its main application 
is as an external antiseptic in 5 per cent, solution over wounds, ulcers and 
so forth, also to disinfect wounds and for antiseptic douches. On account 
of its local anaesthetic action it is sometimes used in itching skin diseases 
as a wash. Dose: — 0.01-0.05 G. up to 0.5 in 24 hours. Br. (1 to 1 grain). 
Average (U.S.P.) 0.065. 

Unguentum Phenolis — 3 per cent. 

Glyceritum Phenolis — 20 per cent. 

Aseptol, or sozolic acid, a 33 per cent, solution of ortho-phenol sulphonic 
acid, brown syrupy liquid which smells like phenol, but is less poisonous 
and less irritant than the latter. It is used for the same purposes externally. 

Sodii Phenolsulphonas, colorless crystals without odor, saline taste, 
soluble in 5 parts water. Dose: — 0.3 to 1.0 G. U.S.P. , 0.25 G. 

Zinci Phenolsulphonas, colorless efflorescent crystals, very soluble in 
water and alcohol. Used as external antiseptic in ^ to 2 per cent, solution 
in the treatment of gonorrhea and ulcerative processes. Dose: — U.S.P., 
0.125 G. 

Resorcinol (U.S.P.) (meta-dioxybenzol), or resorcine colorless crystals, 
very soluble in one part water. 

Formerly used as an antipyretic; now only as an internal and external 
antiseptic. It is very irritant and even a caustic in concentrated solution, 
and, therefore, is best used in the strength of 1 to 2 per cent. It is employed 
to disinfect the gastro-intestinal tract, the vagina, the urethra and rectum. 
Dose: — 0.3 to 6.0 G. up to 3.0 G. in 24 hours. Average (U.S.P.) 0.125 G. 

Pyrogallol (U.S.P.) or pyrogallic acid, light or colorless crystals which 
quickly darken upon exposure to light. It is very soluble in water and 
acts as a strong reducing agent. 

Although it is never used internally, cases of poisoning arise from its ab- 
sorption by the skin after external application. These results forbid the 
application of this substance over large areas of the skin and other absorbing 
surfaces. It is used as a stimulant and antiseptic in skin diseases, especially 
in psoriasis in 5 per cent, to 10 per cent, solution and is best applied to the 



GROUP OF ACETANILID AND PHENOL. 1 35 

spots in the form of collodion. It produces a brown stain which can be 
removed by benzine. On account of this brown coloration it is sometimes 
used to dye hair. In 20 per cent, solution it is used as a caustic. 

Lenigallol, or pyrogallol triacetate, substitute of pyrogaUic acid used in 
the form of 20 per cent, ointment in skin diseases. 

Eugallol (pyrogallol monoacetate). Same use as the above. 

Thymol (U.S.P.,B.P.), obtained from the leaves and tops of Thymus 
Vulgaris; it is a white crystalline body, almost insoluble in water, but soluble 
in alcohol, ether, chloroform and oils. It is also liquefied when rubbed with 
chloral, camphor, menthol and phenol. Dose: — 0.05-0.2 G. Br. (^-3 
grains). Average (U.S. P.) 0.125 G. 

Thymolis Iodidum, reddish-yellow powder, insoluble in water and 
glycerine, slightly soluble in alcohol, easily soluble in ether, chloroform, 
collodion, fixed or volatile oils. Used externally as an antiseptic dusting 
powder, also in ointments, suppositories and in solution in liquid petrola- 
tum 10 per cent, as a spray. 

(F) Creosote Series. 

This series contains a variety of phenol derivatives obtained by the dis- 
tillation of wood tar, especially that obtained from beech. 

Creosotum (U.S.P.,B.P.), clear, oily liquid with a smoky odor, con- 
taining some of the higher phenols, but not carbolic acid. It is less poisonous 
than carbolic acid, but it possesses also antiseptic and antipyretic properties. 
It is now mainly used as an internal antiseptic and also in the treatment of 
phthisis. Given in capsule or emulsion. Dose: — 0.2-1.0 c.c. in 24 hours. 
Br. (1-5 irg). Average (U.S.P.) 0.2 c.c. 

Creosotal (creosote carbonate), clear, thick, amber-colored liquid, in- 
soluble in water, soluble in alcohol. It contains 90 per cent, creosote. 
Same action and uses as creosote. Dose : — 0.2 up to 1.0 c.c. in 24 hours. 

Guaiacol, liquid closely related chemically and pharmacologically to 
creosote, but it is said to be more poisonous than the latter. Same uses as 
creosote. Dose : — 0.2 up to 1.0 G. in 24 hours. 

Duotal (guaiacol carbonate), white crystals insoluble in water, soluble in 
alcohol. Used for the same purposes as creosote. Dose : — 0.2 G. up to 1.0 
G. in 24 hours. 

Benzosol (benzoyl guaiacol), white crystals, same use as previous prep- 
arations. Dose : — 0.2 G. 

Cresol (U.S.P.) , straw colored liquid with aromatic odor soluble in 60 
parts water, miscible with alcohol and glycerine in all proportions. Com- 
posed of three cresols. An excellent external antiseptic. Dose: — Average 
(U.S.P.) 0.5 c.c. 

Creolin, impure preparation of the above, brown liquid, insoluble in 
water, but forming a milky mixture with the latter. It contains various 
cresols, pyridine bases, and resins, obtained from coal tar. Used as an ex- 
ternal antiseptic in the strength of 1 to 2 per cent, solution. 

Lysol is a preparation of creolin made transparent and soluble in water by 
boiling with alkalies. It makes a soapy solution with water. Uses same as 
cresol and creolin. It has the advantage over creolin that instruments 
placed in its solution may be readily seen on account of its transparency. 

Europhen (isobutyl ortho-cresol iodide), yellow, odorless, insoluble 
powder used to dust on wounds as an antiseptic. 



136 CONSTITUTIONAL ORGANIC DRUGS. 

(G) Pyridin Series. 

Pyridin, colorless liquid with a peculiar odor, very soluble in water, 
alcohol and ether. Occasionally used by inhalation in dyspnoea and asthma. 

Iodolum (tetraiod-pyrrol) yellow powder, odorless, tasteless, almost 
insoluble in water. Contains 90 per cent, iodine. Used externally as an 
antiseptic dusting powder. Internally, as a substitute for iodide of potas- 
sium in syphilis. Dose: — 0.03-0.5 G. 

Menthol Iodol. Dose: — 0.03-0.5 G. 

(H) Naphthalene Series. 

Naphthalenum (U.S.P.), hydrocarbon obtained from coal tar. It con- 
sists of volatile, colorless, shining crystals with the odor of coal tar and an 
aromatic taste. Insoluble in water, soluble in 15 parts of alcohol, in ether 
and oils. 

It is used as an internal disinfectant in intestinal catarrh, in dysentery 
and tuberculosis of the intestines. Also as external antiseptic in scabies in 
a 10 per cent, ointment. Dose: — 0.05-0.5 G. up to 6.0 G. in 24 hours. 
Average (U.S. P.) 0.125 G. 

Betanaphthol (U.S. P.), Naphthol (B.P.), white crystal, soluble in about 
1000 parts of water, very soluble in alcohol and ether. Used for the same 
purposes as naphthalene. For skin eruptions it is sometimes employed in 
a 5 per cent, solution. Dose : — 0.05 to 0.5 G. Br. (3-10 grains). Average 
(U.S.P.) 0.25 G. 

Asaprol (calcium sulphonate derivative of naphthol). It is a white 
powder soluble in water and alcohol. It is eliminated by the kidneys which 
it may irritate as naphthalene and naphthol. Same use as naphthalene. 
Dose: — 0.1-1.0 G. 

Epicarin (naphthol and toluic acid derivative), yellow powder, soluble 
in alcohol, ether, and oils. Used as naphthol for scabies inform of ointment. 
Said to be non-poisonous. 

(I) Benzoic Acid Series. 

Acidum Benzoicum (U.S. P., B. P.), white crystals, aromatic odor, 
soluble in alcohol and ether, soluble in about 300 parts water; forms crystal- 
lizable salts with the alkalies. Dose : — 1.0-4.0 G. up to 10.0 G. in 24 hours. 
Br. (8-15 grains). Average (U.S.P.) 0.5. 

Sodii Benzoas (U.S.P.,B.P.), white crystals soluble in 2 parts of water. 
Dose: — 1-4 G. Br. (8-30 grains). Average (U.S.P.) 1.0 G. 

Lithii Benzoas (U.S.P.), white crystals, soluble in 3 parts of water. 
Dose same as the above. 

Ammonii Benzoas (U.S,P.,B.P.), white crystals, soluble in 5 parts 
water. Dose same as the above. 

These substances are used chiefly as expectorants and antiseptics of the 
bronchial and urinary tracts. They are seldom used now as intestinal anti- 
septics. 

(J) Tar Series. 

Pix Liquida (U.S.P.,B.P.), or tar, is a thick brown, syrupy liquid ob- 
tained by the dry distillation of pine wood. It consists of a mixture of 
phenols, cresols and naphthalenes. Dose :— Average (U.S.P.) 0.5 G. 



GROUP OF ACETANILID AND PHENOL. 1 37 

Oleum Picis Liquidae, oil distilled from tar. Dose: — Average (U.S. P.) 
0.2 c.c. 

Syrupus Picis Liquidae. Dose: — 5.0 to 15.0 c.c. Average (U.S.P.) 
4.0 c.c. 

Unguenti Picis Liquidae. 

Anthrasol, or colorless tar, is a decolorized preparation of tar. 

These various tar preparations are used externally in the form of ointments 
for the treatment of skin disease where they act as antiseptics and irritants by 
virtue of their constituents. 

(K) Ichthyol Series. 

Ichthyolum is the ammonium salts of sulphonic acids obtained by dis- 
tilling bituminous deposits of fossil fishes found in Tyrol. It is a viscous, 
reddish-brown liquid, with a bituminous odor and taste, soluble in water, 
glycerine and fats. 

It can be given internally as an antipyretic and disinfectant of the gastro- 
intestinal tract, but its chief use in confined to the treatment of skin diseases 
in the form of an ointment containing 5 to 50 per cent. Dose : — 0.5 to 1.0 
c.c. 

Thiolum is an artificial substitute for ichthyol made by sulphonating 
hydrocarbon of soft coal. It is used very much in the same way as ichthyol. 

Ichthalbin (compound of ichthyol and albumin). It is used mainly 
internally as a disinfectant of the gastro-intestinal tract. Dose: — 0.5 to 
1.0 G. 

(L) Chrysarobin Series. 

Chrysarobinum (U.S.P. ,B. P.), is a yellow powder extracted from Goa 
which is present as an exudation in the lacunae of the trunks of the Brazilian 
tree Andira Araroba. It is present to the extent of 75 per cent, in Goa 
powder, together with chrysophanic acid. It is difficultly soluble in water, 
but it mixes well with oils and fats. In solution in caustic alkalies, it be- 
comes changed by the air to chrysophanic acid. 

It is used externally only as an irritant, antiseptic and antiparasitic in the 
treatment of skin diseases, and especially in psoriasis and taenia as a 5 per 
cent, ointment or collodion. The black stains which it produces on the 
skin can be removed by benzine. 



PART II. 



In this section are to be found a few heterogeneous series of 
substances of animal origin which cannot easily be grouped 
elsewhere. Among these are the digestive ferments, the secre- 
tions and extracts from organs and the artificial foods. 

GROUP OF DIGESTIVE FERMENTS. 

This first subdivision contains the digestive ferments which 
have been used in diseases of the gastro-intestinal tract to replace 
those which are lacking. They are of the three varieties proteo- 
lytic, amylopsic and steapsic: the chief ones are pepsin, pancreatin, 
papain, and different diastases. 

PEPSIN digests proteids in acid media, best in solutions of 
0.2 per cent, hydrochloric acid. It does not act in an alkaline 
reaction, but is even destroyed in a very short time by alkaline 
carbonates. 

Since pepsin or its antecedent, pepsinogen, is almost never ab- 
sent from the stomach contents, except in complete atrophy of 
the mucous membrane or in extensive cancer, its use is indicated 
practically only in these two conditions. In catarrhal processes 
of the stomach, pepsin is usually present, but inactive on account 
of the great diminution or absence of hydrochloric acid. Under 
these circumstances, not pepsin, but hydrochloric acid is indicated 
to render active the pepsinogen which is already present. 

PANCREATIN differs from pepsin in that it digests proteids in 
neutral and alkaline solution and is destroyed by 0.2 per cent, hy- 
drochloric acid. Its only possible use is in cases of decreased 
pancreatic secretion, or where the gastric secretion is totally 
stopped, so that pancreatic, instead of gastric digestion, might be 
carried on in the stomach. 

139 



140 ORGANOTHERAPY. 

The presence of proteolytic enzymes in the vegetable king- 
dom is quite widespread. We find them in the common pine- 
apples, in figs, in the insect-eating plant Drosera and in the 
Brazilian plant, Carica Papaya. The enzyme found in the last 
mentioned plant, papain, is the only one used practically in 
medicine. 

PAPAIN, or papayotin or papoid, digests proteids in alkaline, 
neutral, and acid solutions. It has been employed instead of 
pepsin or pancreatin to help gastric or pancreatic digestion. It 
has also been used to digest croupous or diphtheritic membranes 
in the throat. 

DIASTASE is the enzyme of malt which changes starches into 
sugar. There is also an amylolytic ferment called Taka-dias- 
tase, present in Eurotium Oryzae, as aspergillus. Neither 
Diastase nor Taka-Diastase has any utility in medicine, as 
starch digestion is almost never at fault. The alcoholic malt 
extracts, which are usually sold, have no starch digestive prop- 
erties because the alcohol prevents the action of ferments. 

SUMMARY OF GROUP ACTION.— Digestion of the various 
food stuffs in different reactions according to the ferment. 

MATERIA MEDICA. 

Pepsinum (U.S. P., B.P.), proteolytic ferment obtained from the stomachs 
of pigs, which should be capable of digesting not less than 3,000 times its 
weight of freshly coagulated egg albumin. It is a white, almost odorless 
powder with a slightly bitter taste, soluble in about 100 parts of water, but 
more soluble in acidulated water. Dose: — 1.0-5.0 G. Average (U.S. P.) 
0.25 G. 

Pancreatinum (U.S. P.), a mixture of the enzymes present in the pan- 
creas of warm-blooded animals, usually obtained from the pig. As a rule 
it contains in the active state only the proteolytic and the starch splitting 
ferments, but not the fat splitting ones. It is a yellowish, white powder, 
with a slight odor and taste, slowly soluble in water. Dose: — 1.0-5.0 G. 
Average (U.S.P.) 0.5 G. 

Liquor Pancreatis (B.P.), solution of ferment of pancreatic glands. 
Dose: — 1-2 3. 

GROUP OF BILE. 

BILE of different animals was used empirically in the treat- 
ment of diseases by the ancients. It is, however, only recently 



GROUP OF BILE. 141 

that its pharmacological action has been studied and that ra- 
tional indications for its use have been found. 

The bile acids or their salts are undoubtedly the chief active 
ingredients. When injected subcutaneously or intravenously 
into animals, bile or bile salts produce a depression of the heart 
and central nervous system and decompose the red blood cor- 
puscles. These symptoms are very similar to those observed in 
jaundice in human beings. 

When given by the mouth, they increase the peristalsis of the 
intestines and the absorption of fats, and decrease intestinal 
putrefaction. They are absorbed by the stomach and intestines and 
are carried to the liver where they are in chief part re-excreted. 
During their passage through the liver, they greatly stimulate 
this organ and increase the total secretion and the absolute quantity 
of acids and other solids of the bile, out of proportion to the actual 
quantity of bile or bile salts administered. 

The laxative effect is probably due to the irritation caused by 
the increased amount of free taurocholic and glycocholic acids in 
the intestines. The antiseptic action results from the more 
rapid onward movements of the intestinal contents and from 
the special antiseptic action of free taurocholic acid. The in- 
creased absorption of fat is a sequence of their better saponi- 
fication and emulsification and of stimulation of the absorptive 
powers of the intestinal mucosa. 

The main uses of bile are in the treatment of constipation and 
of conditions when the digestion and absorption of fats are im- 
paired, and as a cholagogue. 

SUMMARY OF GROUP ACTION.— Special stimulant action 
upon the liver causing great increase in both solid and watery con- 
stituents of bile. Laxative and internal antiseptic. Depressive ef- 
fect upon the circulation and destruction of the red blood corpuscles. 

MATERIA MEDICA. 
Fel Bovis Purificatum (U.S.P.), Fel Bovinum Purificatum (B.P.), is 
formed from the fresh bile by the addition of alcohol, filtration and evapora- 
tion to a pasty consistency. It is best prescribed in pills coated with salol 
to prevent action and absorption in the stomach. Dose : — 0.3-2.0 G. Br. 
(8-15 grains). Average (U.S. P.) 0.5 G. 



142 ORGANOTHERAPY. 

GROUP OF ADRENALIN. 

When extracts of the suprarenal gland or its active principle, 
ADRENALIN,* are injected intravenously, changes in the circu- 
lation resembling those produced by the digitalis group are to be 
observed. At first the force of the heart's contraction is strength- 
ened, its rate is decreased and the blood pressure is elevated. 
Later this organ becomes irregular and weakened. The increase 
in the force of the heart is due to stimulation of its muscles, while 
the slowing is the result of stimulation of the pneumogastric 
nerves. The increase in the blood pressure is due to the aug- 
mented force of the heart plus contraction of the peripheral 
vessels. This contraction of the vessels is due to local action 
upon the vaso-cons trie tor endings. 

These symptoms differ from those produced by digitalis, as 
they are of exceedingly short duration; also because the vascular 
effect is infinitely more marked than that on the heart muscle 
and is the chief feature in the rise of blood pressure with supra- 
renal extract. It seems that the contraction of blood vessels 
is not uniform throughout the body and that those of the splanch- 
nic area are the chief ones affected. This influence is of but 
short duration after a single dose, for the blood pressure may re- 
turn to normal in a few minutes. The shortness of action is 
explained by the rapid decomposition of the active principle. 

After often repeated intravenous injections of suprarenal ex- 
tract over a prolonged period of time, arteriosclerotic conditions in 
the aorta may be produced which lead to necrosis of the media 
with deposits of calcium salts. 

When applied locally to a mucous membrane, adrenalin con- 
tracts the blood vessels, and makes it white and bloodless; thus, a 
congested conjunctiva, or swollen turbinate bodies, may be im- 
mediately blanched and shrunken. If there is local hemorrhage 
it may be stopped by this powerful, local, contractile effect on the 
vessels. 

Other nerve endings in smooth muscles than those in blood 

* Also called Epinephrin and Suprarenin. 



GROUP OF ADRENALIN. 1 43 

vessels are also affected. Those in the walls of the bladder, 
stomach and intestines are relaxed, while those of the uterus, 
vagina, vas deferens, seminal vesicles and external genitalia are 
contracted. In the eye, besides contracting the blood vessels, 
suprarenal extract or adrenalin dilates the pupil by stimulating 
the dilator fibers supplied by the superior cervical ganglion. 
They do not act on the muscles supplied by the oculomotor nerve. 

Adrenalin stimulates the protoplasm of the secreting glands, 
just like physostigmin, and this increases the secretions of the 
saliva, of the mucus in the throat and of the sweat. 

After hypodermic injections of large doses in animals, the 
central nervous system is at first stimulated, but later depressed 
followed by death from respiratory failure. Hemorrhages from 
the kidneys and mucous membranes are sometimes observed. 

The sugar metabolism is altered after subcutaneous admin- 
istration so that the percentage of sugar in the blood is increased 
and glycaemia and glycosuria are produced. This is due to the 
specific liberating effect which adrenalin has on the stored sugar. 
Thus the blood is flooded with more than can be temporarily 
oxidized. After internal administration no action is discernible 
because adrenalin is probably decomposed before absorption. 

SUMMARY OF GROUP ACTION.— Powerful stimulation of 
smooth muscle fibers especially in the walls of blood vessels, thus ar- 
resting local hemorrhage and congestion and raising blood pressure 
by injection into the circulation. Also, some stimulant action on the 
heart. No action by internal administration, and fleeting effect 
even by intravenous injection because of ease of decomposition of 
the active principle. 

THERAPEUTIC APPLICATION.— Extracts of suprarenal 
glands and solutions of adrenalin have been employed chiefly 
on account of their constricting influence on blood vessels, to ar- 
rest hemorrhage, and relieve the congestion of the mucous mem- 
branes of the nose, throat and eyes, as in nasal catarrh, hay fever, 
pharyngitis, and conjunctivitis. They have also been employed 
to prevent hemorrhage during surgical operations on the nose and 
throat. 



144 ORGANOTHERAPY. 

Their employment as a stimulant to the circulation in shock is 
objectionable on account of the very fleeting action of the prin- 
ciple. 

Suprarenal extracts have been used, although with little bene- 
fit, in the treatment of Addison's disease, a sickness attended with 
destruction of the suprarenal glands. 

MATERIA MEDICA. 

Glandulae Suprarenales Siccae (U.S.P.), cleaned, dried and powdered 
glands of sheep and ox. Light, yellowish amorphous powder, partly soluble 
in water. Dose: — Average (U.S. P.) 0.25 G. 

Adrenalinum Hydrochloridum, white crystalline body, soluble in 
water, used in solution of 1-1000 to 1-10,000 for local application to mucous 
membranes. This body has also been called epinephrine, suprarenin, 
adrin, adnephrin, suprarenalin, etc., and has been prepared by various firms 
in standard solutions. 



GROUP OF IODOTHYRIN. 

The THYROID GLAND of animals and its active principle 
IODOTHYRIN produce marked changes in the metabolism. 

These consist of a great diminution of weight due to an increase in 
the burning up of the body tissues; at first, of the fats alone, later, also 
of the proteids. The increased destruction of the latter gives rise 
to augmentation of the urea in the urine. The urine is also 
greatly increased in quantity, as are also most of its solid con- 
stituents. Occasionally albuminuria and glycosuria occur. 

The heart is rendered more rapid and the blood pressure is 
lowered; thus, overdoses produce palpitations, weakness and 
collapse. 

The nervous system is also affected so that we may have 
headache, nervousness and tremors. 

Occasionally symptoms of gastro-enteritis may be observed. 
The intensity of these symptoms varies greatly in different indi- 
viduals. Patients suffering from exophthalmic goitre and myx- 
cedema are especially sensitive. All the symptoms of exophthal- 
mic goitre are aggravated by continuous use of thyroid prepara- 
tions, but with myxoedema the reverse is true, if small increasing 
doses are used. In this disease the mucoid oedema gradually 



GROUP OF IODOTHYRIN. 1 45 

disappears. The hair grows again and becomes less dry. The 
heart increases in rate and the urine in quantity. The intellect 
becomes brighter and the patient in due time becomes entirely 
normal. If, however, the use of thyroid preparations is discon- 
tinued in this disease, its symptoms gradually reappear. On 
account of these facts, it has been supposed that myxcedema is 
due to a decrease or absence of the normal secretion of the thyroid 
gland, while exophthalmic goitre is due to an overproduction of 
the secretion of this gland. 

SUMMARY OF GROUP ACTION.— Marked influence on me- 
tabolism causing an increased burning up of first fats, then proteids, 
thus reducing body weight. Specific curative action on myxcedema 
and conditions where there is an insufficiency of thyroid secretion. 
Depression of heart and central nervous system from large doses. 

THERAPEUTIC APPLICATION.— The main use of thyroid 
preparations is in the treatment of conditions where the normal 
thyroid secretion is thought to be decreased, as in myxcedema, 
cachexia strumipriva, cretinism and common goitre. Small doses 
should be given at first to learn the susceptibility of the patient 
in myxcedema and cachexia strumipriva (thyroid gland removed 
by operation). Then it should be continued throughout life. 
It is also sometimes of great value in reducing obesity, but in the 
obese it should be used with care for fear of reducing the weight 
too rapidly and causing undesirable symptoms. The urine 
should be carefully watched and when more nitrogen is excreted 
than is taken in by the food, it should be discontinued. 

A tendency toward sugar in the urine from the use of thyroid 
in obesity, should make one especially cautious in examining the 
urinary secretion often. 

MATERIA MEDICA. 

Thyroid Gland of the sheep contains the proteid thyreoglobulin, which, 
by digestion, is decomposed into globulin and iodothyrin. The fresh gland 
may be administered raw or slightly broiled. Begin with one-quarter or 
one-half a gland per day. 

Glandulae Thyroideae Siccae (U.S. P.). Dried glands of sheep, yellow- 
ish powder, partly soluble in water. Dose: — Average (U.S. P.) 0.25 G. 

Thyroideum Siccum (B.P.), a powder prepared from the fresh thyroid 



I46 ORGANOTHERAPY. 

gland of the sheep. It is a light brownish powder with a meat-like odor. 
Dose: — 2-10 grains in 24 hours. 

Other preparations of thyroid are tablets containing 0.12 G. of the dried 
gland prepared by Parke, Davis; another tablet called Thyraden, 0.25 G. 
of the dried gland, prepared by Knoll and a preparation called "Iodothyrin" 
containing lactose and the same amount of iodine as the gland prepared by 
Bayer. 

Iodothyrin is a white body almost insoluble in alcohol and water, con- 
taining less than 10 per cent, iodine, which possesses the same action as the 
crude gland and is probably its active ingredient. 



HORMONES. 

Since Sterling demonstrated the stimulant action which certain 
bodies in the living organs normally exert on various secretions, 
an attempt has been made to place one of these in practical appli- 
cation. This one is the hormone which produces increased per- 
istalsis and was called by Zueltzer HORMONAL. It has been 
used successfully by this author and others in the treatment of 
constipation. It is administered subcutaneously every few days. 
Its action lasts for several days. 

OTHER ANIMAL EXTRACTS. 

Extracts of other organs, as thymus gland, testicles, ovaries, 
spleen, bone marrow and pituitary bodies, have been tried in 
therapeutics without much more than psychical effects. 

Thymus gland contains a principle which lowers blood pressure 
and causes death by collapse, when given in very large quantities. 
It has been recommended in exophthalmic goitre, but without 
much effect. 

Testicular extract was first recommended by Brown-Sequard 
as a rejuvenator and has been used more or less since, although 
without any apparent effect. Pohl introduced instead of tes- 
ticular extract, an alkaloid spermin isolated from testicles, and 
claims for it marked action in improving the metabolism in 
neurasthenia and other conditions. 

Ovarian extract has been recommended for conditions of dis- 
turbed metabolism occurring in women at the menopause or in 
undeveloped girls. 



TOXINES, ANTITOXINES, VACCINES. 1 47 

Spleen and bone marrow extracts have been employed in 
different blood diseases, especially pernicious anaemia, on the 
theory that they might increase the blood-forming elements of 
the bone marrow and spleen. These have likewise been without 
results. 

Pituitary extract has been recommended in acromegaly on 
the theory that the disease is due to a diminution of that gland. 



TOXINES, ANTITOXINES, VACCINES. 

TOXINES are a class of poisons of a highly complex, chemical 
composition and sometimes partaking of the albuminoid nature. 
They are found widely distributed, especially in the lower plant 
life as bacteria, but also in higher plants, as in the castor-bean or 
ricinus, the jequirity, common croton tiglium, etc. They occur 
in animal organisms, especially as the product of bacterial action 
under pathological conditions, and some of the most serious 
diseases of animal life are due to these products of bacterial ac- 
tivity. Among the many such, may be cited diphtheria, tetanus, 
typhoid fever, bubonic plague, cholera, etc. 

Some of these toxines produce a pharmacological action not 
very different from that of some well-known drugs. Thus tetanus 
toxine produces the same tetanic convulsions which are observed 
after strychnine or its allies. Nevertheless, the mode of action 
differs considerably, because these substances act in immeasur- 
ably small amounts, and in suitable conditions, they tend to 
stimulate the formation in animal organisms of chemical sub- 
stances foreign to these, which have the power of combining 
chemically with the toxines and rendering these innocuous. 
These are called ANTITOXINES. Some of the toxines when ad- 
ministered in small amounts have the power of stimulating the 
phagocytic activity of living cells towards the bacteria which 
have produced that toxine. Furthermore, they may stimulate 
the power of the living cells to actively destroy the toxines. 

After many infectious diseases, the living organism loses the 
power of contracting the same disease again for a varying time of 



148 ORGANO-THERAPY. 

from a few weeks, or a few years, to a complete lifetime. Thus 
syphilis and several of the exanthemata are generally accepted 
not to recur during the lifetime of an individual. This protec- 
tion is called acquired immunity, and the principle is used in 
therapeutics in order to prevent diseases. It is called vaccina- 
tion and was first introduced in connection with small-pox, 
when variolization was employed. The principle has been to 
diminish the virulence of the germs and thus the intensity of the 
inoculated disease. The first attempt at attenuation was prac- 
tised by Jenner, when he immunized human beings against 
small-pox, by the use of the allied but much less virulent cow-pox. 
Since that time many other vaccinations have been introduced, 
and among the most successful may be mentioned that against 
rabies. More recently favorable results have been obtained by 
vaccination against typhoid fever and bubonic plague. 

Occasionally, after the use of some antitoxic serum, as that of 
diphtheria, sudden death has occurred in man and in experi- 
mental animals. Researches on this point have shown that 
certain highly complex bodies, as albumins and albuminoids, have 
the power diametrically opposite to immunizing, i. e., they sensi- 
tize the organism in which they are introduced. Thus horse- 
serum may be given in considerable doses without ill effects to a 
guinea-pig who has never received an injection of this substance 
previously. When, however, a dose even so small as toVo °f 
the original innocuous one is administered some days, weeks or 
even months later, the animal dies suddenly with symptoms of 
respiratory failure. At autopsy the cause of death is found to 
be spasmodic contraction of the bronchiole. This phenomenon of 
sensitization is known as ANAPHYLAXIS. 



DIPHTHERIA ANTITOXINE. 

Diphtheria antitoxine is obtained by immunizing horses with 
diphtheria. This is done by gradually injecting increasing doses of 
the diphtheria toxine. The serum obtained is titrated in strength 
with known toxines and is standardized in the term of units. 



TETANUS ANTITOXINE. 1 49 

The standardized serum is injected both in cases of existing 
diphtheria and also as a prophylactic measure to those who come 
in contact with infectious foci, as physicians, nurses and family 
of the afflicted. The results obtained since its introduction by 
Roux have been astounding. In the Boston City Hospital, prior 
to 1895, the mortality from diphtheria was 46 per cent., while in 
five subsequent years after the introduction of the antitoxine, 
the mortality dropped to 12 per cent. 

TETANUS ANTITOXINE. 

This antitoxine has not given as favorable results as that of 
diphtheria, probably chiefly because the toxines of tetanus travel 
from the wound to the central nervous system by way of the 
nerves, while the antitoxine follows the lymphatic and blood chan- 
nels and finds great difficulty in penetrating nerve tissue. Never- 
theless, if the antitoxine is administered before convulsions occur, 
it may produce a certain prophylactic action. 

SERUM OF CEREBRO-SPINAL MENINGITIS. 

During the last few years great advance has been made in the 
serum treatment of cerebro-spinal meningitis, and from different 
countries, reports of great reduction in death-rate are published. 
The serum is injected intradurally and is believed to act by 
stimulating the phagocytes in destroying the cocci and their 
endo toxines. 

SNAKE-VENOM ANTITOXINES. 

Calmette, working with the venom of cobra and other poison- 
ous snakes, was able to produce antitoxines which protect animals 
against the toxines present in these venoms. There is consider- 
able difficulty in applying these to human beings. 

ANTITHYROID SERUM. 

The principle of antitoxine has also been applied to the correc- 
tion of autointoxication from excess of some internal secretion. 



1 50 ORGANOTHERAPY. 

Lately serum obtained from thyroidectomized goats and from 
other sources, has been employed, with a certain degree of success, 
in detoxicating the system from excess of the thyroid secretion in 
the disease Exophthalmic Goitre. 

ARTIFICIAL FOODS. 

Artificial foods have been prepared for cases of malnutrition 
where an insufficient amount of ordinary food is taken. We have 
among the proteid variety innumerable proprietary preparations 
of albumen, albumoses and peptones, some nucleo-proteids con- 
taining phosphorus, also carbohydrate preparations, especially 
represented by the infant foods and malted milks, and lastly, 
different preparations of fats, the oldest being cod liver oil. 

These preparations have no particular superiority over the 
natural foods and, on the contrary, are often unpalatable, which 
in itself would make them less digestible. Thus, preparations 
of albumen, albumoses and peptones have seldom any advantage 
over properly prepared eggs or meat, proprietary foods for infants 
and invalids over common cereals, as tapioca, arrowroot or rice, 
and lastly, fat preparations or cod liver oil over cream, butter, 
olive oil or the fats in eggs or meat. 



PART III. 



This part contains drugs which are used in medicine chiefly 
for their local effects and, in fact, although most of them have 
a general action, it is the local one which is of greater prominence. 
It includes not only those substances which affect the place of ap- 
plication but also the place of excretion. Thus, with the division 
of urinary antiseptics, it is for local effect at the place of excretion, 
i. e., urinary tract, that these substances are used. 

All the members of this part have local irritant action with 
the exception of some in the section of mechanical agents. Al- 
though we have attempted a classification according to the 
most common therapeutic application, yet the members of one 
group could easily be described in another from a purely phar- 
macological standpoint. The volatile oils used as urinary dis- 
infectants present very nearly the same qualitative action as 
those described under skin irritants, and croton oil, given under 
purgatives, could be appropriately grouped with the skin irritant 
toxicodendrol. 

SKIN IRRITANTS. 

Almost all foreign substances which penetrate into the skin 
cause irritation, e. g., volatile bodies are irritants because they 
diffuse easily through the skin. Heat and cold are irritants of 
different intensity, depending on how much the rise or lowering 
of temperature departs from that of the body. Thus with these 
we may have all degrees of inflammation from redness to gan- 
grene. Many drugs, when taken internally, such as iodides, 
bromides and mercury, may produce irritation of the skin, which 
is due either to an excretion of the medicine or its product by 
the same, or to a congestion of the vessels due to central action. 



152 LOCAL ORGANIC DRUGS. 

In this section we include only those drugs whose chief action is 
irritation by local application. 

The irritation of the skin due to any drug always takes the 
form of ordinary skin inflammations of different grades, depend- 
ing on the strength and quantity of the irritant, upon the sus- 
ceptibility of the person and upon the place of application. 
Thus, poison ivy may, under some conditions, only produce an 
erythema, while under other circumstances it may give rise to 
papules, blisters, pustules and even ulcers. The subjective symp- 
toms vary according to the intensity of action, as itching, burning 
or pain. 

Besides the purely local action upon the skin, these irritants 
also influence in a reflex manner certain internal functions. 
Therefore mild skin irritation produces an increase in the force, 
depth, or frequency of respiration. It also increases the force of the 
heart beat resulting in a rise of blood pressure. Very severe skin 
irritation over a large area produces the reversed condition, i. e., 
a decrease in the efficiency of the respiratory centre and heart with 
a fall of blood pressure, e. g., a condition of collapse such as is 
seen after extensive burns. 

The metabolism is increased by mild or moderate irritation 
of the skin so that we have an increased excretion of nitrogen 
and carbon dioxide. 

The internal temperature is said to rise after mild dermal irri- 
tations and to fall after severe ones. The former is due to in- 
crease in metabolism, the latter to collapse. In fever, however, 
skin irritation may materially lower the body temperature by 
changing the distribution of the blood. Since in moderation it 
contracts the internal blood vessels and dilates the superficial 
ones, the hot blood is brought to the surface and cooled. The 
effect of cold baths in fever is a double one, producing a lower- 
ing of temperature by contact with cold and also by leaving the 
superficial blood vessels dilated after the bath. The influence of 
alcohol sponging is on the same order. 

The skin irritants also affect the local circulation of organs. 
They are said to increase the circulation in parts directly under 



SKIN IRRITANTS. 1 53 

the skin to which they are applied, but to decrease it in organs 
lying deeply beneath the same, counter-irritation. Thus, if 
applied to the chest they would produce hyperaemia of the inter- 
costal muscles, but anaemia of the lungs. 

For convenience of description, the skin irritants are divided 
into three groups, according to whether the action is due to the 
volatility of a substance, to the volatility plus special irritant 
properties, or to special irritant properties of a non- volatile body. 



GROUP OF TURPENTINE OIL. 

The action of this group is possessed by all volatile substances 
which are easily diffusible, such as the volatile oil of plants, includ- 
ing the oils of turpentine, cajuput, eucalyptus and arnica, sabine, 
juniper, cubeb, etc., and the artificial volatile hydrocarbons of 
the fatty acid series and their derivatives, including chloroform, 
ether and alcohol. Yet we restrict ourselves here to the descrip- 
tion of the volatile oils found in plants which are chiefly composed 
of hydrocarbons, called ter penes. 

These substances, on account of their easy difTusibility, pro- 
duce their local effects almost immediately after application. This 
is never very severe, unless much of the substance is kept in con- 
tact with the skin for a long time, because they escape quickly by 
evaporation. For this reason also their action is of short duration. 

The irritation as a rule consists only of a feeling of warmth, 
itching and redness. Because of the ease with which they pene- 
trate protoplasm, they all have antiseptic action which varies 
somewhat with the different members, turpentine being one of the 
most active. When the volatile oils are taken internally in 
small doses, they produce a feeling of warmth in the stomach and 
often eructation of gas. They undoubtedly increase the move- 
ments of the upper gastro-intestinal tract. They also produce a 
hyperaemia of these parts and may increase the absorption 
of food stuff and also the glandular secretions. Another factor 
may act in this respect, i. e., the odor and taste of the pleasant 
volatile oils, which in a psychical way may improve the digestion; 



154 LOCAL ORGANIC DRUGS. 

in this way we probably can explain the good effects of after-din- 
ner cordials. The leucocytes of the blood are also increased by 
the volatile oils. 

When taken internally in large quantities, as, for instance, sabine 
which has been used to produce abortion, they cause severe gas- 
troenteritis with nausea, vomiting, and diarrhoea, intense pains 
and colic, great weakness of the heart and respiration, bloody 
and albuminous urine, even anuria and death in collapse. 

They are excreted by the urine partly as such, partly oxidized 
and partly in combination with glycuronic acid. Large amounts 
passing through the kidneys produce intense nephritis, but with 
small quantities there may be observed only an aromatic odor 
and a slight increase in the urinary secretion. The latter is 
more or less antiseptic and it is on this account that a few oils, 
as that of cubeb, copaiba and sandalwood, are used as urinary 
disinfectants. 

When injected into animals, there is usually to be observed a 
stage of increase in the cerebral and medullary functions, i. e., 
greater excitement and increase in respiration and blood pressure. 
Only with a few, as oil of absinthe, the cord is markedly stimulated 
and even convulsions may be observed. After the stage of 
stimulation, the entire nervous system becomes paralyzed and 
death takes place from failure of respiration. 

Very little is known about the chronic action of volatile oils 
except that the regular and too copious drinking of cordials 
may lead to hyperacidity and other disturbances of the stomach. 
In the case of absinthe, however, there occur very frequently, 
insanity and epilepsy in the habitues which may be accounted 
for by the action of the volatile oil on the brain. 

GROUP OF MUSTARD OIL. 

When both black and white mustard are treated with water, 
there develops in each a different volatile oil, that of the former 
having specific irritant properties besides those due to its vola- 
tility. 



SKIN IRRITANTS. 1 55 

The OIL OF BLACK MUSTARD being volatile, acts very 
rapidly but much more intensely than the essential oils of the 
previous division because it has specific irritant properties. It 
also acts much more deeply than the members of the next division 
which are non- volatile, and the inflammation caused by the former 
is more difficult to cure than that of the latter. The degree of 
irritation depends upon the concentration, length of exposure, 
etc., and may vary from simple erythema to vesication, pustulation 
and even formation of ulcers. 

Taken internally in small quantities, mustard acts as a con- 
diment and increases the appetite and digestion, but in cases 
where the stomach is hypersensitive, as in hyperacidity, it may 
produce burning and distress. In large quantities it acts as a 
powerful emetic. 

Mustard plasters do not cause irritation rapidly because 
the oil has to be gradually formed from its antecedents by the 
moisture of the skin before they can act. 

GROUP OF CANTHARIDIN. 

This division includes the non-volatile substances having special 
irritant properties. The chief members are the active principles 
of Spanish flies, of poison ivy and poison oak, of cayenne pepper 
and of kaschew. 

As these substances are non-volatile and not easily absorbed 
by the skin, the irritation comes on much later than with the 
members of the previous division, but it is of longer duration, 
because of the slow elimination. 

CANTHARIDIN, the active principle of Spanish flies, produces 
very severe but less painful skin irritation than mustard oil be- 
cause it is not volatile and does not penetrate so deeply. When 
taken internally, it causes intense burning and pain in the mouth, 
oesophagus, stomach and bowels. The colics may be excruciat- 
ing. If taken in solution, blisters may be observed in the mouth 
and throat and the pain in the oesophagus may be so severe 
as to prevent deglutition. Violent vomiting and purging, pain 



156 LOCAL ORGANIC DRUGS. 

in the bladder, inability to pass urine (the little that is passed 
is albuminous and bloody), dyspnoeic respirations, convulsions 
and death in collapse are the chief symptoms of poisoning in 
man. 

As may be observed, the symptoms in man are dependent 
on the frightful local irritation of the gastro-intestinal and urinary 
tracts. They are also due to the action on the central nervous 
system, which consists of paralysis of the vital centres. Can- 
tharidin is excreted by the kidneys. 

The susceptibility of cantharidin towards different animals 
varies enormously ; thus in the hen and hedgehogs large quanti- 
ties may be taken without much effect, while in the rabbit a small 
dose, as in man, will produce intense symptoms of poisoning. 

Capsaicin, mezerein and euphorbin have much the same 
action as cantharidin. 

When extracts of POISON IVY or solutions of its active alkaloid 
are applied to the skin, or when persons are accidentally poisoned 
by the plants, a feeling of warmth and itching develops in from 
twenty-four hours to eight days after exposure. In a few hours 
an erythema appears, quickly succeeded by papules. In many 
areas these are replaced by small blisters and even large blebs, 
which may leave ulcerations. These skin lesions are accompanied 
by more or less oedema, which is, however, only well marked on 
the face and genitals (testicles and penis), which as a rule show 
few other lesions, but the oedema there is of great intensity, 
swelling the face to twice its normal size, completely occluding 
the eyes by enormously swollen lids. The most intense symptoms 
may last from three to six days, then they abate, and the skin 
returns to normal condition, after having peeled. 

The main features of the treatment of such poisoning con- 
sists of scrubbing the affected parts with soap and water in order 
to remove the active principle. The application of the alcoholic 
solution of lead acetate is also of value by precipitating the active 
ingredients. The use of fatty substances is contraindicated be- 
cause they have a tendency to dissolve and spread the poison. 



SKIN IRRITANTS. 157 

After internal administration symptoms of gastro-intestinal 
and renal irritation are to be seen, just as with cantharidin. 

The oil CARDOL, obtained from the Jamaican Kaschew, pro- 
duces exactly the same effects. A case of cardol poisoning is 
indistinguishable from one of poison ivy. 

SUMMARY OF GROUP ACTION.— Irritation of the skin at the 
place of application and also of the kidneys where excreted. Taken 
internally gastro-intestinal tract much irritated. Action on the 
central nervous system of secondary importance. 

THERAPEUTIC APPLICATION.— Skin irritants are some- 
times painted over ulcers to improve the circulation and hasten 
the repair, as for instance in the form of tincture of myrrh. 

They are used to decrease pain reflexly, in the form of mus- 
tard and cantharides plasters for pain in the chest, turpentine 
stupes for the abdomen and counterirritant liniments for in- 
flamed joints. Tincture of Cantharides is frequently put in hair 
restorers to stimulate the growth of hair. 

They are applied on the skin over deep-seated exudations or 
transudations, such as water on the knee. Formerly they were 
much employed in the form of plasters to decrease inflammation 
of the deep-seated organs, as the lungs, stomach, intestines, etc. 

Mustard, pepper and capsicum are used in small doses, as 
gastric stimulants to improve digestion and appetite. In large 
quantities mustard is given as an emetic. 

On account of their irritant action and disinfectant properties, 
turpentine and terpene hydrate are sometimes of value as ex- 
pectorants and bronchial antiseptics. 

Cantharides was formerly used in small doses as a diuretic 
and by the laity to produce sexual excitement. The internal 
administration of this substance is exceedingly dangerous on 
account of its marked poisonous effect; the majority of the re- 
corded cases of poisoning have' resulted from this mode of ap- 
plication. Oil of sabine has been used chiefly illegitimately as 
an abortifacient and is of interest from the number of cases of 
poisoning resulting from this employment. 



158 LOCAL ORGANIC DRUGS. 

MATERIA MEDICA OF SKIN IRRITANTS. 

Turpentine Division. 

Terebinthina (U.S. P.)- Thus Americanum (B.P.), concrete oleoresin 
from Pinus Palustris, composed of yellowish, opaque, crumbly masses. 
Dose: — 1.0-4.0 G. Br. (15-45 grains). 

Oleum Terebinthinae (U.S.P., B.P.), obtained by distilling the above. 
Dose: — 0.2-2.0 c.c. Br. (5 T^-4 5). Average (U.S. P.) 1.0 c.c. 

Resina or Rosin, residue after the distillation of turpentine. Used to 
make plasters. 

Terpini Hydras (U.S. P.), rhombic crystals, soluble in 250 parts H 2 
and 10 parts alcohol. Dose: — 0.1-1.0 G. Average (U.S.P.) 0.125 G. 

Terebenum (U.S.P. , B.P.), colorless liquid with a turpentine-like odor. 
Dose: — 0.3-1.0 c.c. Br. (5-15 tfe). Average (U.S.P.) 0.5 c.c. 

Oleum Eucalypti, volatile oil obtained by the distillation of Eucalyptus 
Globulus. 

Eucalyptol (U.S.P.), chief constituent of the oil of eucalyptus. It is a 
colorless liquid with an aromatic odor, soluble in alcohol and insoluble in 
water. Dose: — 0.3-1.0 G. Average (U.S.P.) 0.3 G. 

Oleum Cajuputi, volatile oil obtained from Cajuputi Virideflora. 

Oleum Arnica, volatile oil from Arnica Montana. 

Oleum Sabinae, volatile oil from Juniperus Sabina. 

Mustard Division^ 

Sinapis Alba (U.S.P.), Sinapis Albae Semina (B.P.), the dried seeds of 
Brassica Alba. This contains the glucoside sinalbine and the ferment 
myrosin. In the presence of water myrosin decomposes sinalbine with the 
formation of oil of mustard, sinapine and glucose. 

Sinapis Nigra (U.S.P.), Sinapis Nigrae Semina (B.P.), the dried seeds 
of Brassica Nigra. It contains the glucoside sinigrin and the ferment 
myrosin. The latter decomposes sinigrin in the presence of water into 
allylisosulphocyanate of potassium, or the volatile oil of mustard and glucose. 

Charta Sinapis (U.S.P., B.P.), paper treated with extracts of mustard. 

Linimentum Sinapis Compositum contains the volatile oil of mustard, 
mezereum and camphor. 

Thiosinamine, formed from volatile oil of black mustard, has been rec- 
ommended to remove scars. 

Fibrinolysin, solution of double salt of Thiosinamine with sodium sali- 
cylate, containing 15 per cent, of the double salt. Used instead of thiosina- 
mine by subcutaneous, intravenous or intramuscular injection to remove 
scar tissue from various parts of the body. 

Cantharides Division. 

Cantharis (U.S.P., B.P.) consists of the dried beetles Cantharis Vesi- 
catoria or Spanish fly. It contains cantharidin, an acid anhydride formed 
of colorless crystals, soluble in alcohol, ether, chloroform and slightly soluble 
in H 2 0. 

Ceratum Cantharidis (U.S.P.). 

Collodium Cantharidatum (U.S.P.). 

Tinctura Cantharidis (U.S.P., B.P.) . Dose:— 0.05-0.5 c.c. Br. (1-5 
nu). Average (U.S.P.), 0.3 c.c. 



URINARY ANTISEPTICS. 1 59 

Mezereum (U.S. P.), Mezerei Cortex (B. P.), bark of Daphne Mezereum 
which contains the irritant resin, mezerein, besides the glucoside daphnine. 

Fluidextractum Mezerei. Dose : — 0.05-0. 5. 

Capsicum (U.S.P.,B.P.), fruit of Capsicum Fastigiatum, a plant of 
Central and South America. It contains the oleoresin, capsicol, and the 
crystalline capsaicin. 

Tinctura Capsici (U.S. P.). Dose : — 0.5-4.0. Average (U.S. P.) 0.3 c.c. 

Emplastrum Capsici (U.S. P.). 



URINARY ANTISEPTICS. 

GROUP OF SANDALWOOD AND CUBEB OILS. 

The volatile oils of CUBEB, COPAIBA, SANDALWOOD and 

JUNIPER are closely related chemically and pharmacologically. 
They are terpene derivatives and differ in no essential points 
from the other volatile oils described under skin irritants, so that 
the general pharmacological action of volatile oils also applies to 
this division. 

They are excreted in part by the bronchi, but chiefly by the 
kidneys in combination with glycuronic acid. Not all of the oil 
is combined with the latter ; a part is excreted unchanged, while 
another portion is transformed into an oxidation product before 
excretion. They have a certain amount of local irritant action 
which makes itself evident at the points of absorption and excre- 
tion, but these substances are a little less irritant than other vola- 
tile oils and with small doses are less apt to produce violent gastro- 
intestinal disorders. The oil of sandalwood seems to produce 
less irritation than those of cubeb and copaiba. 

The medical administration of these bodies is not infrequently 
accompanied by pain in the stomach with dyspeptic and enteric 
symptoms, and also by pain in the back, over the bladder 
and in the urethra after micturition. When large doses are 
ingested, severe nausea, vomiting and diarrhoea may ensue; 
the urine may become albuminous, bloody, and diminished in 
quantity on account of the irritation of the kidneys. 

After the administration of cubeb and copaiba, an eruption of 
the skin may occur. This rash takes the form of an erythema, 
papules or urticarial weals and is usually not accompanied by 



l6o LOCAL ORGANIC DRUGS. 

fever. The skin may break out even after smoking cubebs, as 
is frequently done by laymen in certain parts of the country as a 
cure for catarrh of the air-passages. Sometimes symptoms of cere- 
bral disturbance have been observed after large doses of cubebs. 

During their passage through the kidneys, these substances 
stimulate the secretory structures and in medicinal doses may 
increase the renal secretion. They also delay the decomposition 
and putrefaction so that the urine may remain clear for several days 
after it is passed and when it does become cloudy, there are few 
or no putrefactive bacteria. On account of their excretion in 
combination with glycuronic acid by the urine, they may give 
the Fehling reduction and thus simulate the presence of sugar. 

By virtue of their partial excretion through the bronchial 
mucous membranes, they stimulate its secretion and act also in 
this place as disinfectants. 

The presence of albumin may be shammed in the nitric acid 
test by the RESINS present in the crude preparation of cubeb and 
copaiba, because they give rise to a precipitate. These resins are 
possessed of an action very similar to, but much less powerful than, 
that of the oils upon the urinary and gastro-intestinal tracts. 

BUCHU may be placed in this group because it contains a vola- 
tile oil which has much the same action as those of cubeb and 
copaiba. UVA URSI or bearberry contains certain glucosides 
called arbutin and methylarbutin, which are excreted by the 
urine partly unchanged and partly transformed to hydroqui- 
nones. These bodies may give to the urinary secretion a smoky 
color, especially on standing, when the unchanged arbutin may be- 
come decomposed by the bacteria. Just as the oils mentioned 
above, but not in so marked a manner, uva ursi acts as a genito- 
urinary antiseptic. 

GROUP OF HEXAMETHYLENAMINE. 

HEXAMETHYLENAMINE, formerly known under the pro- 
prietary name of urotropine, together with its compounds, hel- 
mitol and citrarin, is excreted by the kidneys, decomposed into am- 
monia and formaldehyde. This excretion also takes place in 



URINARY ANTISEPTICS. l6l 

other parts of the body, as in the gall-bladder, etc. On account 
of the presence of the latter in the urine, these substances are 
among the most powerful urinary antiseptics. In cases of typhoid 
fever with many Eberth bacilli in the urine, it has been shown that 
urotropine causes a more rapid disappearance of these bacteria 
than would normally occur. In animals, large quantities of these 
substances may produce albuminuria and haematuria. Hexa- 
methylenamine or its products, chinotropin, sahformin and he- 
tralin, form soluble compounds with uric acid, but whether or not 
this combination helps the excretion of the latter, still remains to 
be decided. 

A few "GOUT REMEDIES" may be conveniently mentioned 
now. When the theory was evolved that the cause of gout 
was the overproduction, precipitation and retention of uric acid, 
physicians administered alkalies with the idea of dissolving or 
keeping in solution the difficultly soluble uric acid and thus to 
facilitate its excretion. No remarkable results were obtained 
from the alkali metals and earths, so organic bases were tried. 
These form very soluble salts with uric acid and among them 
are piperazine and its compounds, including sidonal, lycetol 
and lysidine. More recently the question was attacked from 
another aspect. Quinic acid, a substance present in the bark 
of cinchona and many other trees is said to decrease the forma- 
tion of uric acid and itself is transformed and excreted as hip- 
puric acid. Different compounds of quinic acid with the same 
action are urol, urocol, urosin, and sidonal. 
' SUMMARY OF GROUP ACTION.— Excretion by the kidneys 
with stimulation after small doses, and irritation of these organs with 
large quantities. Antiseptic action on the genito-urinary tract. 
With too great doses, gastro-intestinal irritation. 

THERAPEUTIC APPLICATION.— Preparations of cubeb, 
copaiba and sandalwood have been used so extensively in the 
treatment of gonorrhoea of the genito-urinary tract that they are al- 
most regarded as specifics in this disease. Since the urine, after 
their ingestion, does not check the growth of the gonococci, it is 
probable that they do not produce their good effect by destroying 



1 62 LOCAL ORGANIC DRUGS. 

these bacteria, but by preventing the decomposition of the urine 
remaining in contact with the diseased membrane and so decreas- 
ing the irritation and the lowering of the vitality of the tissues 
which would afford a better field for the development of the dis- 
ease. The best results are to be obtained in the earlier stages of 
this affection, but in the chronic form, and gleet, but little im- 
provement is observed. These oils and their preparations are also 
indicated in acute inflammation of the bladder and pelvis of the 
kidneys. They increase the flow of urine through their irritant 
action upon the renal tissue, and may be used as diuretics when 
there is no acute inflammation or extensive degeneration of the 
kidneys. Their stimulant and disinfectant effect upon the bron- 
chial mucous membranes recommends them in dry bronchitis. 

/Of late years the artificial bodies hexamethylenamina or 
urotropine, helmitol and citrarin, chinotropin, saliformin 
and hetralin have come in vogue as substitutes for the substances 
previously mentioned. They are more efficacious in acute cys- 
titis and pyelitis because their antiseptic action is more marked; 
although, like the oils, they are of but little value in chronic in- 
flammation of the urogenital tract. Their efficacy in acute 
gonorrhceal urethritis is warmly endorsed by many physicians. 

Hexamethylenamine has been employed internally as an anti- 
septic to the gall-bladder, also in case of purulent ears, in colds in 
the nose with infections of sinuses and with inflammation of 
serous cavities, as in pleurisy, synovitis, etc. 

All the members of- the Hexamethylenamine division haye 
been and are used for gout by some doctors, yet most authori- 
ties have observed very little good effect from any of them. It 
is not surprising, for we know very little about the cause of this 
trouble and uric acid seems to be more a product than a causative 
factor in the disease. 

MATERIA MEDICA. 
Cubeb and Copaiba Division. 

Copaiba (U.S.P.,B.P.), Balsam of Copaiba, Copaiva, the oleoresin 
of Copaiba Langsdormi and of other species of Copaibae. Dose: — 
0.5-1.0 c.c. Br. 0^-i fl. dr.). Average (U.S.P.) 1 c.c. 



GROUP 01 VEGETABLE PURGATIVES. 1 63 

Oleum Copaibas U.S.P..B.P/. ike oil freed from the resin by distilla- 
tion. Dose: — 0.5-1 c.c. 10-15 -7 . Average U.S. P. 0.5 c.c. 

Cubeba U.S. P. . Cubebae Fructus B.P, . Cubebs, the unripe fruit of 
Piper Cubeba. containing the oil of cubeb and cubebin. Dose: — 2-$ G. 
(30-120 grs/ 1 in powder. Average U.S. P. 1 G. 

Oleoresina Cubebae U.S. P.. Dose: — o.;-i c.c. t'10-15 ttjj). Average 
(U.S.P. 0.5 G. 

Oleum Cubebae U.S. P. .B.P. . Dose: — 0.5-1 c.c. ,10-15 1L • Aver- 
age U.S. P.' 0.5 c.c. 

Oleum Santali U.S.P..B.P.). Sandalwood oil. distilled from the wood 
0: Santalum Album. Dose: — c.5-1 c.c. ,10-15 U. • Average U.S. P.) 
0.5 c.c* 

Buchu U.S. P. .B.P. . leaves of Barosma Betulina. Dose :— 2.0-4.0 G. 
Br. : i-i3). Average U.S. P. 2.0 G. 

Fluidextractum Buchu U.S.P.d Dose: — 2.0-4.0 c.c. 

Uva Ursi U.S. P. . leaves of Arctostaphylos Uva Ursi or Bearberry. 

Fluidextractum Uva Ursi U.S. P. . Dose: — ;.o-i;.o c.c. 



Hexamethylenamina Division. 

Hexamethylenamina U.S. P. . known under the trade names of 
urotropine. undone, cystogen. cystamme. formim aminoform, ammoniofor- 
maldehyde. composed of colorless crystal with bitter sweet taste, easily 
soluble in water. Dose: — Average U.S. P. 0.25 G. 

Helmitol ana Citrarin, white crystalline compounds of hexamethyien- 
amina and citric acid. Dose, same. 

Liquor Formaldehydi U.S. P. . Formaline, a 57 per cent, solution of 
formaldehyde gas in water, Used as a 'disinfectant of utensils, etc. 

Chinotropin ana Chinoformin, quinic acid compounds of hexamethyl- 
enamine. Dose, same. 

Piperazina, crystals easily soluble in water. Dose: — 1-2 G.* 



GROUP OF VEGETABLE PURGATIVES. 

The following is also a group of local irritants like the preceding 
ones. Many of its members when applied to the skin produce 
very severe irritation, as. for example, croton oil. In medicinal 
doses the various purgatives do not produce, when taken inter- 
nally, severe irritation of the entire alimentary canal mcluding 
mouth, oesophagus, stomach, small and large intestines, but they 
exhibit their effects more or less specifically on the lower portion 
of the gastro-intestinal tract where many of these are excreted 
even after subcutaneous ad mini stration. 

Recent work has shown a well-marked seiectiveness of different 
members of this group for certain parts of the gastro-intestinal 



164 LOCAL ORGANIC DRUGS. 

tract, whether they are introduced by mouth or intravenously. 
Thus, Magnus, by the x-ray method, has shown that senna has 
no action on the stomach and small intestines, while castor oil 
increases the peristalsis of the small intestine actively but not of 
the #tomach. Castor oil caused purgation by decreasing the 
antiperistaltic activity of the large intestine, while senna acts as 
a distinct stimulant to peristalsis of the colon, besides, by 
special stimulation, when in the cecum, it causes reflex defecation. 
Padberg, a pupil of Magnus, investigated the mode of action of 
colocynth and found that it sometimes increases and sometimes 
decreases the emptying of the stomach. However, it always 
stimulates the peristalsis of the small intestine and inhibits the 
antiperistalsis of the large intestine. It causes defecation only by 
the rectal reflex and not by the cecal reflex, like senna. 

This group comprises many substances of very different com- 
positions extracted from the vegetable kingdom. Some of these 
are oils, as castor and croton oils, others are anthracene deriva- 
tives, as chrysophanic acid and emodin. Still others are gluco- 
sides as podophyllin and podophyllotoxin and finally others are 
acid anhydrides like elaterin. 

These substances all have one property in common, that of in- 
creasing the peristalsis of the intestine by special local irritant action. 
They produce hyperaemia and it is probable that they increase 
both the movements and secretions of the intestinal tract. 
The secretions are only markedly increased after very large 
doses and assume the character of exudates, while the more 
fluid nature of the stools with small doses is due to the hastened 
peristalsis which does not allow of the reabsorption of the fluids. 
The increase in peristalsis is not only in the large intestines, but 
also in the small ones, and with the drugs, aloes and rhubarb, an 
increase in the movements of the stomach is also observed. 

After copious doses of these purgatives, the evacuations are 
watery and the patient suffers from stomachache and cramps, 
probably due to the violent spasmodic contraction of the in- 
testines, but the sensitiveness of the abdomen after too large 
quantities is due to actual inflammation. 



GROUP OF VEGETABLE PURGATIVES. 1 65 

They have much less effect upon the stomach than upon the in- 
testines, because many require for their solution and preparation 
alkaline juices, as the bile and pancreatic secretions. Castor 
oil, for instance, has no action before it is changed to ricinoleic 
acid, which takes place much more readily in the small intestines 
than in the' stomach. 

Most purgatives, while producing a hyperaemia of the intes- 
tines, also produce a congestion of the neighboring generative 
organs. In this way they may increase hemorrhage from the 
uterus at the times of menstrual periods, or they may set up 
contractions of this organ and bring about abortion during preg- 
nancy. 

Some of these cathartics, as podophyllin, podophyllo toxin, 
colocynthin and croton oil act as purgatives when given sub- 
cutaneously. It is probable that their, action is due at least in 
part to excretion by the intestinal mucous membranes. They 
produce severe irritation at the place of application, and also 
of the kidneys, and are, therefore, impracticable when admin- 
istered subcutaneously. 

Depending upon the dose and susceptibility of the patient, 
most purgatives act in from 6 to 10 hours. Aloes may not pro- 
duce its effect before fifteen hours. Croton oil may act in two 
hours. 

In habitvial constipation, which is so frequent with the 
sedentary habits of modern life, it is very common for physicians 
to prescribe and patients to use on their own authority, various 
drugs of this group for periods of months and years, but almost 
always with a growing decrease in the effects produced. Many 
of these patients show on examination, a tender, thickened colon 
which is probably the result of the long chronic irritation that 
might have been avoided if, instead of irritants, exercise and regu- 
lation of the diet had been prescribed for the constipation. 

Although the pharmacological action of the purgatives or that 
part of it which we know at the present, does not present sharp fea- 
tures of distinction, yet for convenience, they are divided into 
four groups based chiefly on their chemical composition. 



1 66 LOCAL ORGANIC DRUGS. 

CASTOR OIL DIVISION. 

This subdivision includes two oils, Castor and Croton oils, 
which although quite different in strength act more or less in the 
same manner, i. e., after decomposition into fatty acids. 

CASTOR OIL or RICINOL is very bland and unirritating and 
when pure, causes no stimulation of the skin, mouth, throat or 
stomach, but on reaching the small intestines it becomes saponi- 
fied and ricinoleic acid and ricinoleates are formed which have a 
marked irritant action and by this means increase the intestinal 
peristalsis. If ricinoleic acid or ricinoleates are applied to the 
skin or given internally, redness of the epidermis, a burning acid 
taste in the throat, nausea, and vomiting occur. As a rule, no 
constitutional disturbance follows the ingestion of even large 
doses of castor oil and not even severe gastro-intestinal inflamma- 
tion. It seldom produces much griping or pain. 

This action, however, only applies to the expressed oil, for the 
castor beans themselves are very toxic; one has produced fatal 
poisoning, which consists of exceedingly severe gastro-enteritis 
with excruciating pains in the abdomen, nausea, vomiting, 
cyanosis, failure of the heart and respiration, and death in col- 
lapse. This very toxic action is due to the presence of a toxal- 
bumin called RICIN, but as it is not soluble in oils it remains 
behind while expressing the castor beans. 

CROTON OIL is a much more powerful purgative than the 
preceding. If more than a very small dose is given, it produces 
vomiting and purging (which may be bloody), intense cramps, 
tenderness of the abdomen and general collapse. With small doses, 
as a fraction of one drop, it causes only profuse, watery purgation. 

Its action is due to the decomposition of croton oil into tigliic 
acid, a change which takes place very readily in the small intes- 
tines. Ordinary commercial croton oil, as a rule, contains con- 
siderable of this acid preformed, so that it is in contrast to castor 
oil, very irritating. If injected into the skin it produces violent 
inflammation with pustulation. It causes a burning sensation 
along the throat, oesophagus and stomach, and often induces 



GROUP OF VEGETABLE PURGATIVES, 1 67 

vomiting. The chemically pure croton oil containing no free 
tigliic acid is absolutely as bland and unirritating to the skin as 
olive oil yet it produces as much irritation of the bowels and purg- 
ing as the commercial because it is decomposed there into the 
acid. 

ALOIN AND RHUBARB DIVISION. 

A number of crude drugs, as RHUBARB, ALOES, SENNA, 
CASCARA, and FRANGULA, contain the same or some very 
closely allied chemical substances which are anthracene deriva- 
tives. Among them are eniodin, chrysophanic acid, cathartin, 
frangulin and aloin which have purgative action, but strangely 
enough, not so powerful as the crude drugs. 

The amount of purgation induced by all these substances de- 
pends upon the quantity and form of administration and also 
upon the class of animal receiving them. 

Emodin, cathartin, frangulin and the amorphous aloin pro- 
duce purgation when isolated from the mother substance. Chry- 
sophanic acid when given pure does not cause purgation because 
it is too rapidly absorbed. It is possible that in crude drugs mixed 
with colloids, it is less rapidly absorbed and much more active. 
This acid is again excreted by the urine, to which it imparts a 
yellow color often seen after taking rhubarb and senna. The 
milk of nursing women may also have a yellow color and purge 
babies, after taking these drugs. 

Aloin, frangulin and cathartin are purgatives when injected 
subcutaneously and probably produce this effect through excre- 
tion by the bowels which has been proved for aloin. The latter 
does not irritate the kidneys in man, dogs and cats, but produces 
very destructive processes in rabbits. Aloin produces marked 
peristalsis of the stomach. 

PHENOLPHTHALEIN DIVISION. 

This includes phenolphthalein and its various derivatives and 
allies, but the title substance is the chief one used in medicine 
at present. 



1 68 LOCAL ORGANIC DRUGS. 

Phenolphthalein, its derivatives and allies act as purgatives in 
man, but much more slowly than the crude vegetable purgative 
drugs, sometimes only in twenty or twenty-four hours. Phenol- 
phthalein and its tetra-chlor derivative exert a laxative or purga- 
tive action also when given subcutaneously and intravenously. 
When a solution of the tetra-chlor derivative of phenolphthalein 
(0.4 G.) in oil is injected under the skin of dogs and human beings, 
a laxative action is induced which lasts from four to six days. 

These phthaleins are non-irritant when applied to mucous 
membranes or wounds or injected subcutaneously in oily solution. 
Their sodium and potassium salts, however, are very irritant. 

When phenolphthalein is injected subcutaneously it escapes 
both by the bile and urine, but the tetra-chlor compound only 
leaves by the bile. After internal administration, none of the 
tetra-chlor derivative leaves by any other channel than the in- 
testine. An interesting proof of the selectiveness of these com- 
pounds on certain parts of the intestines is that only the cells of 
the large intestine take up tetra-chlor phenolphthalein, while 
those of the small intestine take up none whatever. Phe- 
nolphthalein gives the urine a bright red color when the latter is 
alkaline. 

Purgatine, trioxyanthrachinon, causes purgation in man, but 
when given to rabbits produces a yellowish, then a brownish-red 
port- wine color in the urine and without causing any purgation 
the animals die with extensive destruction of the kidney and loss 
of weight just as with aloin. In dogs, although the urine is 
colored red, no serious symptoms appear even after taking the 
drug for a period of months. 

ELATERIN AND PODOPHYLLIN DIVISION. 

The acid anhydrides and glucosides Elaterin, Jalapin, Con- 
volvulin, Scammonin, Colocynthin, Podophyllotoxin and Picro- 
podophyllotoxin form a division of very active cathartics which 
give rise to watery evacuations. Elaterin, jalapin and convol- 
vulin require the presence of bile to dissolve them before they 
act, just as does aloes; but bile also helps the action of all the 



GROUP OF VEGETABLE PURGATIVES. 1 69 

other purgatives. Podophyllotoxin, picropodophyllin and 

colocynthin cause purgation when injected subcutaneously. 
This is due to a partial excretion by the intestines. They cause 
violent irritation at the place of injection and are very apt to 
bring about severe inflammation of the kidneys due to excretion 
of part of these substances by the latter organs. All the members 
of this division are much more irritant than those of the rhubarb 
group and in sufficient doses give rise to vomiting and diarrhoea, 
often of a bloody character, with reddening and ecchymoses of the 
intestinal mucosa. The irritation may be so severe as to produce 
collapse. With podophyllotoxin even a pseudomembrane forma- 
tion has been observed. 

SUMMARY OF GROUP ACTION.— Special stimulation and 
irritation of the bowels leading to purgation. With large doses 
actual inflammation of gastrointestinal tract. By subcutaneous ad- 
ministration catharsis, also violent irritation at place of application 
and of kidneys. 

THERAPEUTIC APPLICATION.— Almost all the members of 
this group may be used in small doses to produce mild evacua- 
tions of the bowels and thus relieve constipation, or in large doses 
to cause severe purgation. For convenience the milder ones, 
such as castor oil, senna, aloes, rhubarb and cascara are 
used as laxatives and mild purgatives, while croton oil, jalap, 
colocynth, podophyllum and camboge are used as drastics, i. e., 
for severe purgative action. 

Croton oil is used almost exclusively in unconscious patients, 
especially those suffering from apoplexy. Here it is supposed to 
do good by lowering the blood pressure and thus aiding the arrest 
of the hemorrhage. This it may do both by producing a dilata- 
tion of the splanchnic blood vessels and by decreasing the bulk 
of blood through watery evacuations. 

The use of purgatives is indicated in all cases when the intestine 
is to be emptied, as after poisoning from drugs and from food 
products, or when there is infection of the intestines, as in typhoid 
fever, or autointoxication due to fermentation or putrefactive 
changes in the intestinal contents. 



170 LOCAL ORGANIC DRUGS. 

They should not be used when there is severe inflammation of the 
intestines, and only with caution during pregnancy. As a rule 
the active principles do not act so well as the crude drugs, prob- 
ably because the colloidal substances in the latter prevent rapid 
absorption and decomposition, thus keeping them longer in con- 
tact with the mucous membrane. 

MATERIA MEDICA. 
Simple Purgative Series. 

Oleum Ricini (U.S.P.,B.P.), castor oil, a yellowish, viscid fixed oil 
expressed from the seeds of Ricinus Communis. It has a very disagreeable 
odor and taste. The seeds contain besides this oil, the toxalbumin, ricin, 
which, however, is not extracted by expression of the oil. Dose : — 5.0-50.0 
ex. Br. (1-8 fl.5). Average (U.S.P.) 16.0 c.c. 

Senna (U.S.P.) , Senna Alexandrina (B.P.), the leaflets of Cassia Augusti- 
folia and Acutifolia trees growing respectively in India and Africa. It con- 
tains the glucoside emodine and the glucosidal acids, cathartic acid and 
chrysophanic acid. 

Infusum Sennae Compositum (U.S.P.) (black draught) contains senna, 
manna, magnesium sulphate and fennel. Dose: — 25.0-50.0. 

Infusum Sennae (B.P.). Dose: — }4-i fl.5. 

Pulvis Glycyrrhizae Compositus (U.S.P.) (compound licorice powders) 
contains senna, sulphur, fennel, sugar and licorice. Dose: — 2.0-8.0. 
Average (U.S.P.) 4.0 G. 

Aloe Socotrina (U.S.P.), inspissated juice from Aloe Perriji, a tree 
growing in Africa and Isle of Socotra. Aloe Barbadensis (B.P.), inspissated 
juice from Aloe Vera. They are formed of brown resinous masses and 
contain the neutral principle aloin, emodin and a resin. 

Extractum Aloes (U.S.P.,B.P.). Dose:— 0.03-0.2 G. Br. (1-4 
grains). Average (U.S.P.) 0.125 G. 

Aloe Purificata (U.S.P.). Dose:— 0.03-0.5 G. Average (U.S.P.) 
0.25 G. 

Tinctura Aloes. Dose:— 1.0-4.0. Br. (J^-i5). Average (U.S.P.) 
2.0 c.c. 

Pilula Aloes. Dose: — 1-4 pills. Br. (4-8 grains). 

Aloinum. Dose: — 0.05-0.2. Br. (K -2 grains). Average (U.S.P.) 
0.065 G. 

Rheum (U.S.P.) or rhubarb, the roots of Rheum Officinale, and Rhei 
Radix (B.P.), root of Rheum Palmatum containing chrysophanic acid, 
emodin, cathartin and a resin. 

Pilulae Rhei Compositae (U.S.P., B.P.). Dose:— 1-5 pills. 

Tinctura Rhei (U.S.P., B.P.). Dose :— 4-16 c.c. Br. (1-4 3). Average 
(U.S.P.) 2.0 c.c. 

Tincturae Rhei Composita (B.P.). Dose:— j^-i 3- 

Frangula (U.S.P.), or Buckthorn, the bark of Rhamnus Frangula, a 
tree growing in Asia and Europe. It contains emodin and frangulin. 

Fluidextractum Frangulae (U.S.P.). Dose:— 2.0-8.0. Average 
(U.S.P.) 1.0 c.c. 



GROUP OF VEGETABLE PURGATIVES. 171 

Rhamnus Purshiana (U.S.P.), or Cascara Sagrada (B.P.), the bark of 
Rhamnus Purshiana, a tree growing in California and Spanish North Amer- 
ica. It contains emodin and cascarin. 

Fluidextractum Rhamni Purshianae (U.S.P.). Dose: — 2.0-8.0 c.c. 
Average (U.S. P.) 1.0 c.c. 

Extractum Cascarae Sagradae Liquidtun (B.P.). Dose: — ^-i fl. 3. 

Phenolphthalein, white crystalline body difficultly soluble in H 2 0, 
turning red in the presence of alkalies. Dose: — 0.1-0.2 G. 

Exodin is a mixture of anthraquinone derivatives. Dose : — 0.5-1.0 G. 



Drastic Series. 

Scammonium (U.S. P.), Scammoniae Radix (B.P.), resinous exudate 
from the roots of Convolvulus Scammonia, an herb growing in Asia and 
Greece. It contains the glucoside Jalapine. 

Resina Scammoniae (U.S. P.). Dose:— 0.05-0.5 G. Average (U.S.P.) 
0.2 G. 

Scammoniae Resina (B.P.). Dose: — 3-8 grains. 

Jalapa (U.S. P., B.P.), the tuberous roots of Ipomcea Jalapa, a plant 
growing in Mexico and India and containing the glucosides jalapin and 
convolvulin. 

Extractum Jalapse (B.P.). Dose: — 0.1-0.5 G. Br. (2-5 grains). 

Resina Jalapae (U.S.P.,B.P.). Dose: — 0.5-0.3. Br. (2-5 grains). 
Average (U.S.P.) 0.125 G. 

Pulvis Jalapae Compositus (U.S.P., B.P.), containing jalap and potas- 
sium bitartrate. Dose: — 1.0-4.0. Br. (15-60 grains). Average (U.S.P.) 
2.0 G. 

Oleum Tiglii (U.S.P.), Oleum Crotonii (B.P.), a fixed oil expressed from 
the seeds of Croton Tiglium, a tree growing in India and the Philippines. 
The oil usually contains free tigliic or croton oleic acid. Dose: — 0.005- 
0.10 c.c. Br. {Yi-\ ttjO- Average (U.S.P.) 0.05 c.c. 

Colocynthis (U.S.P.), Colocynthidis Pulpa (B.P.), fruit of Citrullus 
Colocynthis, which grows in Asia and Africa and contains Colocynthin. 

Extractum Colocynthidis Compositum (U.S.P.,B.P.). Dose: — 
0.03-0.1 G. Br. (3.15 grains). Average (U.S.P.) 0.5 G. 

Elaterinum (U.S.P., B.P.), a neutral principle obtained from the juice 
of the fruit of Ecballium Elaterium or Squirting Cucumber. It is composed 
of white crystals with an acrid bitter taste. Dose: — 0.002-0.005 G. Br. 
tWo grain). Average (U.S.P.) 0.005 G. 

Trituratio Elaterini (U.S.P.). Dose :— 0.03-0.05. Average (U.S.P.) 
0.03 G. 

Podophyllum (U.S.P.), PodophylH Rhizoma (B. P.), rhizome and roots of 
Podophyllum Peltatum, which grows in America. It contains the isomeric 
glucosides podophvllotoxin and picropodophyllin. 

Resina PodophylH (U.S.P.), PodophylH Resina (B.P.). Dose:-o.o5~ 
0.2 G. Br. (1-3 grains). Average (U.S.P.) 0.05 laxative; 0.015 purgative. 

Podophvllotoxin. Dose: — 0.005-0.06. 

Euonymus (U.S.P.), Euonymi Cortex (B.P.), the dried root bark of 
Euonymus Atropurpureus or Spindle tree, contains the glucoside Euony- 
min which is both a purgative and heart poison and also the glucoside atro- 
purpurin. 



172 LOCAL ORGANIC DRUGS. 

Extractum Euonymi(U.S.P.). Dose:— 0.05-0.3 G. Average (U.S.P.) 
0.125 G. 

Extractum Euonymi Siccum (B.P.). Dose : — 1-2 grains. 

Cambogia (U.S.P., B. P.), gum resin from Garcinia Hanburii, which 
grows in Siam, Anam, Cambogia and Cochinchina. It contains the resinous 
acid, cambogic acid. 

Pilulae Catharticae Compositae (U.S.P.) contain besides camboge, 
calomel, colocynth and jalap. Dose : — 1-3 pills. 

Pilulae Cambogia Composita (B.P.). Dose: — 4-8 grains. 



GROUP OF BITTERS. 

Bitter medicines, such as quassia, have been used for a long 
time as remedies in the treatment of digestive disturbances and 
in a certain number of cases the appetite returns and patients 
improve. 

A large number of bodies isolated from plants which have the 
common characteristics of possessing a bitter taste, form this 
group. Among these are alkaloids, glucosides, acids, and neutral 
bodies, all of which have little or no general action in the doses 
used in medicine. Such bitter alkaloids as strychnine and 
quinine, which have a powerful constitutional action, are ex- 
cluded. The substances belonging to this division are not devoid 
of constitutional action, but on the contrary, such bodies as 
Berberine, Canadine, Lupulinic Acid, etc., may produce very 
severe poisonous effects when given in excessive doses intraven- 
ously to animals ; but when given in ordinary doses internally to 
man, they cause none but the local effect on the gastro-intestinal 
tract. 

SIMPLE BITTERS produce in man, as a rule, increase in the ap- 
petite, and secondarily an augmentation in the gastric secretion which 
is due in main part to reflex stimulation through the gustatory 
nerves, on account of the bitter taste. 

The increase in gastric secretion is best seen when a meal 
containing meat is given soon after the bitters, and may amount 
to 25 per cent, above the normal. Being more or less irritant, 
they cause a hyperaemia of the mucous membrane of the gastro- 
intestinal tract which leads to an increase in the absorption of 
food stuff. They also augment the movements of the stomach 



VEGETABLE BITTERS. 1 73 

and small intestine. After very large doses, or in subjects 
with hyperacidity, they cause a burning along the oesophagus 
and stomach, sometimes even nausea and vomiting. The bitters 
increase the leucocytes in the blood and also for this reason may 
increase the absorption and transportation of nutriments from 
the stomach and intestines into the various tissues. 

There are a certain number of crude drugs, as bitter orange, 
cardamom, cinnamon and ginger, which are called AROMATIC 
BITTERS and they contain besides a bitter principle, a volatile 
oil which reinforces their action and gives them a greater tendency 
to irritate the mucous membranes. 

SUMMARY OF GROUP ACTION.— Through their Utter taste, 
stimulants to appetite and through their local irritant action stimu- 
lants to the digestive secretions of the alimentary canal. Too large 
doses produce marked irritation with nausea, vomiting and diarrhoea. 

THERAPEUTIC APPLICATION.— The bitters are used al- 
most exclusively in the form of crude preparations to increase 
the appetite and improve the digestion in cases of malnutrition 
from almost any cause, as consumption, cancer, ancemia, neuras- 
thenia and dyspepsia. Their use is not attended with good 
results in cases with hyperacidity and ulcer, because they may 
further increase the hydrochloric acid and sensitiveness of the 
stomach. 

In former times, one of these bitters, condurango, was used 
as a specific against cancer. The results obtained were not 
sufficiently good to warrant the continuance of this remedy. 
Undoubtedly temporary improvement obtained in cases of gas- 
tric carcinoma was due to the bitter action of this drug in increas- 
ing appetite and facilitating digestion. 

MATERIA MEDICA. 

Simple Bitters. 

Quassia (U.S. P.), Quassia Lignum (B.P.), wood of Picrasma Excelsa, a 
tree growing in Jamaica. It contains quassin, a neutral body, and is said 
to produce headaches, nausea and vomiting in too large doses. 

Fluidextractum Quassias (U.S. P.). Dose: — 1.0-2.0 c.c. Average 
(U.S.P.), 0.5 c.c. 



174 LOCAL ORGANIC DRUGS. 

Tinctura Quassiae (U.S.P.,B.P.). Dose: — 2.0-4.0 c.c. Br. (15-60 njj). 
Average (U.S. P.) 2 c.c. 

Condurango, Gonolobus bark, vine of Ecuador, contains 2 alkaloids, 
a glucoside and a resin. The glucoside injected in dogs produces ataxia 
and convulsions. Dose: — 1.0-2.0 G. 

Calamus (U.S.P.) contains the glucoside acorine and the alkaloid cala- 
mine. Dose: — Average (U.S.P.) , 1.0 G. 

Fluidextractum Calami (U.S.P.). Dose: — 1.0-4.0 c.c. Average 
(U.S.P.), 1.0 c.c. 

Cimicifuga (Racemosa), black snakeroot, native of North America. 
Contains bitter resin and tannic acid. 

Fluidextractum Cimicifugae. Dose: — 1.0-4.0 G. 

Cuspariae Cortex (B.P.), Angostura bark from tropical South America 
contains cusparine and other alkaloids. Dose : — 0.5 to 2.0 G. 

Infusum Cuspariae (B.P.). Dose: — 1-2 fl. §. 

Calumba (U.S.P.), Calumbae Radix (B.P.), the roots of Jateorrhiza Pal- 
mata, which grows in Africa and East Indies and contains the neutral 
columbin, the alkaloid berberine and columbic acid. 

Tinctura Calumbae. Dose: — 4-15 c.c. Br. (1-4 fl. 5)- Average 
(U.S.P.), 4.0 c.c. 

Gentiana (U.S.P.), Gentiana Radix (B.P.), root of Gentiana Lutea. It 
contains the glucoside gentiopicrin and the neutral body gentisin. 

Extractum Gentianae (U.S.P., B.P.). Dose:— 0.1 to 0.5 G. Br. (2-10 
grains). Average (U.S.P.), 0.25 G. 

Tinctura Gentianae Composita (U.S.P., B.P.). Dose: — 1.0-15.0 c.c. 
Br. (J4-4. fl. 5). Average (U.S.P.), 4.0 c.c. 

Cetraria (Icelandica) contains lichenin and cetraric acid. 

Decoctum Cetrariae, 30-100 c.c. 

Chirata (B.P.), from Swertia Chirata, grows in India and contains the 
glucoside chiratin and ophelic acid. 

Tinctura Chiratae (B.P.). Dose:— 2.0-8.0 c.c. Br. (1-2 fl.5). 

Humulus (U.S.P.), Lupulus (B.P.), hops, grows in America and Europe. 
It contains lupulin and lupulinic acid and a resin. Lupulin when injected 
into animals produces first stimulation then depression of the medulla. 
Dose: — Average (U.S.P.), 2.0 G. 

Tinctura Lupulini (B.P.). Dose:— )4-i fl. 5- 

Coto, bark of tree growing in Peru. It contains cotoin. 

Fluidextractum Coto. Dose : — 0.3-2.0 c.c. 

Cormus (Florida), dogwood, grows in North America and contains cor- 
min. 

Extractum Cormi, 1.0-2.0 c.c. 

Serpentaria (U.S.P.), Serpentaria Rhizoma (B.P.), from Aristolochia, 
Virginia snake-root, contains the alkaloid aristolochine. 

Fluidextractum Serpentaria (U.S.P.). Dose: — 1.0-2.0 c.c. Average 
(U.S.P.), 1.0 c.c. 

Tinctura Serpentaria (U.S.P., B.P.). Dose:— 2.0-8.0 c.c. Br. {y 2 -\ fl. 
5). Average (U.S.P.), 4.0 c.c. 

Taraxacum (U.S.P.), Taraxacum Radix, root of dandelion, or Taraxa- 
cum Officinale, contains taraxacin and taraxacein. 

Fluidextractum Taraxaci (U.S.P.). Dose: — 1.0-10.0 c.c. Average 
(U.S.P.), 8.0 c.c. 

Succus Taraxaci (B.P.). Dose:— 1-2 fl. 5. 



VEGETABLE ASTRINGENTS. 1 75 

Orexine Hydro chlorate, artificial base, composed of colorless crystals, 
soluble in 15 parts of water. It has a bitter sharp taste. When injected 
into animals it produces tremors, convulsions, dyspnoea and methaemo- 
globinaemia when mixed with blood, but in man it produces no symptoms 
but those referable to the bitter action. Dose : — 0.1 to 0.3 G. 



VEGETABLE ASTRINGENTS. 

Astringents are substances which make an insoluble and con- 
tractile compound with proteid and in so doing, upon abraded 
surfaces or mucous membranes, check the secretions, arrest hemor- 
rhage and decrease congestion. In great concentration, most 
astringents are irritant and some even caustic as they attack the 
life of the living cells. 

Astringents are of two kinds, vegetable and metallic, but in 
this place we will concern ourselves only with the former and 
leave the latter to be described under the groups of metals. 

GROUP OF TANNIC ACID. 

In the root, wood and bark of many trees, we find some variety 
of tannin or tannic acid. The extracts of those of oak, sumach 
and witch hazel have been used for many years to check hemor- 
rhage, to decrease secretions and to control inflammations of 
mucous membranes. 

This application is based on the property which TANNIC ACID 
possesses of precipitating proteids and albuminoid substances 
into a white, tough, contractile compound: it is with tannic 
acid that hides are transformed to leather. When it is applied 
over wounds or mucous membranes, the layer of the albuminous 
compound, by contraction, squeezes the vessels and glands under- 
neath. By this pressure and the direct chemical combination 
between the proteid of the gland and the tannic acid, the secre- 
tions are stopped. 

In very diluted solutions, this acid constricts blood vessels 
and also stops the movements of the leucocytes and their diape- 
desis through their vessel walls. In this way inflammatory pro- 
cesses may be controlled. Very strong solutions are irritant 



176 LOCAL ORGANIC DRUGS. 

and may cause the reverse, i. e., dilatation of blood vessels and 
inflammatory reactions. 

Superficial hemorrhages are arrested by the narrowing of 
the vessels due to the squeezing of the contractile membrane 
over them and also by a thrombus formation in their lumen, due 
to the precipitation of the proteids of the blood by the tannic acid. 

When it is taken internally, there is a puckery feeling in the 
mouth, throat and tongue. The latter also loses some of the 
perception of taste. If the solution is a diluted one, as a rule, 
no further symptoms except constipation are observed. These 
are all due to the precipitation of the albumin in the superficial 
layers of the mucous membrane. If, on the other hand, much of 
a concentrated solution is imbibed, there occur nausea, vomiting, 
and frequently diarrhoea which result from the irritant action of 
large quantities; therefore the symptoms after the ingestion of 
too large doses of tannic acid are those of gastro-enteritis. 

The proteid compounds of tannic acid are dissolved by gastric 
juice, acids and alkalies. After having acted in the stomach 
they may again produce an astringent effect on the bowels. 
The astringent action of tannic acid stops, however, when, as ulti- 
mately occurs in warm-blooded animals, the latter is trans- 
formed into gallic acid and is absorbed mainly as such. It is all 
oxidized in the body, except about one per cent., which reap- 
pears in the urine and feces in the form of both sodium tannate 
and gallic acid, but chiefly as the latter. Both these substances 
do not precipitate proteids and have in consequence no astringent 
•effect, so that the use of these or of tannic acid internally for this 
action on remote organs, as kidneys and lungs, cannot be attended 
with good results. The intravenous injection of tannic acid is 
not practicable because it causes embolism and death by pre- 
cipitating the proteids of the blood. 

The urine, on standing, sometimes develops pyrogallol from 
the decomposition of the gallic acid. 

The crude preparations of this group, as the extracts of 
hamamelis, oak, catechu, etc., do not affect the stomach as 
much as pure tannic acid, because it requires a certain length of 









VEGETABLE ASTRINGENTS. 1 77 

time for the tannin to be extracted from the colloids in these; 
so that they have always been chosen instead of the pure prepara- 
tions when an astringent effect on the bowels was desired. 

Lately, however, there were introduced newer artificial com- 
pounds of tannic acid with albumen and different substances 
which prevent the decomposition and action on the stomach, 
but which are readily dissolved and decomposed by the pan- 
creatic juice and exert marked astringent action on the intestines. 
Among these bodies are Tannalbin, Tannigen, Tannocoll and 
Honthin. 

SUMMARY OF GROUP ACTION.— Formation of insoluble 
compounds with proteids over mucous membranes and abraded sur- 
faces, causing a decrease of secretions, congestion and of hemorrhage 
with small amounts, but marked congestion and inflammation with 
large quantities. 

THERAPEUTIC APPLICATION.— A solution of tannic acid 
is used externally over bleeding wounds in the skin or external 
mucous membranes, as nose, mouth and pharynx. It is also em- 
ployed in the form of injections in the treatment of inflammatory 
conditions of the vagina, urethra and large intestines, as gonor- 
rheal vaginitis, urethritis and ulcerative colitis. 

Tannic acid is not used uncombined internally because it 
produces too much action upon the stomach. In former times, 
in its place the crude extracts containing tannin were employed 
because they contained colloidal material which prevented it 
from acting so readily upon the gastric mucosa. 

Lately the undesirable effect upon the stomach has been in 
good part obviated by the use of artificial preparations, tannigen, 
tannalbin, tannopin and honthin, which are not readily or not 
at all dissolved in the stomach, but are decomposed by the alka- 
line secretions of the intestine where they can assert their astrin- 
gent action. They are valuable in diarrhoea from catarrhal or 
ulcerative conditions. 

MATERIA MEDICA. 

Acidum Tannicum (U.S.P., B.P.), tannic acid, tannin or gallotannic 
acid, an organic acid extracted from nutgall. It is a yellowish, amorphous, 



178 LOCAL ORGANIC DRUGS. 

scaly powder with slight odor and astringent taste, soluble in 1 part of H 2 0, 
0.6 part of alcohol and 1 part of glycerine. Dose: — 0.1-0.5. Br. (2-10 
grains). Average (U.S. P.), 0.5 G. 

Collodium Stypticum contains 20 per cent, tannic acid. 

Trochisci Acidi Tannici (U.S. P.) contains 0.06 tannic acid. Dose: — 
1-3 troches. 

Unguentum Acidi Tannici (U.S. P.) contains 20 per cent, tannic acid. 

Glyceritum Acidi Tannici (U.S. P.), Glycerinum Acidi Tannici (B.P.), 
contains 20 per cent, tannic acid. 

Acidum Gallicum (U.S.P., B.P.), pale yellow needles obtained from 
nutgall, soluble in 100 parts of water, 5 parts of alcohol, and 12 parts of 
glycerine. Dose: — 0.3-1.0. Br. (5-15 grains). Average (U.S. P.), 1.0 G. 

Synthetic Tannic Acid Compounds. 

Tannigen, acetic ester of tannic acid, tasteless, odorless powder, almost 
insoluble in H 2 0, insoluble in gastric juice, but dissolved by alkalies and 
intestinal juices. Dose: — 0.5-1.0 G. 

Tannalbin, albuminous compound of tannic acid, light brown, odorless, 
tasteless powder, insoluble in gastric juice and water, but soluble in alkaline 
intestinal juices. Dose: — 1.0-4.0 G. 

Tannopin, compound of urotropine and tannic acid, brown, tasteless, 
odorless powder, insoluble in H 2 0, weak acids and alcohol, but easily soluble 
in alkalies. Dose: — 0.5-1.0 G. 

Honthin, keratinized compound of tannic acid, same general properties 
as the above. Dose: — 1.0-4.0 G. 

Tannocol, compound of gelatine and tannic acid. Same general prop- 
erties as the above. Dose: — 1.0-4.0 G. 

Tannoform, compound of formaldehyde and tannic acid. Same general 
properties as the above. Dose: — 1.0-4.0 G. 

Crude Preparations Containing Tannic Acid. 

Galla (U.S.P.,B.P.) (Nutgall), excrescence on Quercus Lusitanica caused 
by the punctures and deposited eggs of the insect Cynips Gallae Tinctoriae, 
smooth, hard, olive green body with a central cavity. It contains about 
60 to 70 per cent, tannic and 2 to 3 per cent, gallic acid. 

Tincturae Gallse (U.S.P.) contains 20 per cent, nutgall. Dose: — 2.0-8.0 
c.c. Average (U.S.P.) , 4.0 c.c. 

Unguentum Gallae (U.S.P., B.P.) contains 20 per cent, nutgall. 

Quercus Alba (U.S.P.), the bark of Quercus Alba or white oak, contains 
quercitannic acid and quercin. 

Fluidextractum Querci (U.S.P.). Dose: — 1.0-4.0 c.c. Average (U.S.P.), 
1.0 c.c. 

Catechu (B.P.), an extract from the leaves of Acacia Catechu, contains 
catechu- tannic acid and catechuic acid. 

Tinctura Catechu (B.P.). Dose:— l A~i fl. 3- 

Krameria (U.S.P.), Krameriae Radix (B.P.), the root of Krameria 
Triandra or rhatany, a plant growing in Peru and Bolivia, contains kramero- 
tannic acid. 

Tinctura Krameriae (U.S.P., B.P.). Dose:— 1 .0-10.0 c.c. Br. Q4-2 fl. 3). 
Average (U.S.P.), 4.0 c.c. 



WORM REMEDIES. 1 79 

Kino (U.S. P., B.P.), inspissated juice of Pterocarpus Marsupium which 
grows in the East Indies. It contains kino-tannic acid and kinoin, a neutral 
body. 

Tinctura Kino (U.S.P., B.P.). Dose:— i.o-io.o c.c. Br. {j4~2 fl. 5). 
Average (U.S. P.), 4.0 c.c. 

Hamamelidis cortex (U.S.P.), Hamamelidis Folia (B.P.), witch-hazel, 
leaves of Hamamelis Virginiana, which grows in North America and contains 
about 8 per cent, tannic acid. 

Fluidextractum Hamamelidis Foliorum (U.S.P.). Dose: — 2.0-8.0 c.c. 
Average (U.S.P.), 2.0 c.c. 

Extractum Hamamelidis Liquidum (B.P.). Dose: — 5-15 tt£. 

Haematoxylon (U.S.P.), Haematoxylon Lignum (B.P.) logwood, wood 
of Haematoxylon Campechianum, growing in Central America and West 
Indies. It contains tannic acid and 12 per cent, hematoxylin. 

Extractum Haematoxyli (U.S. P.). Dose: — 0.3-1.0 G. Average (U.S. P.). 
1.0 G. 

Decoctum Haematoxyli (B.P.). Dose: — y 2 -\ fl. 3- 

Rubus (U.S.P.), blackberry, the bark of the root Rubus Villosus Cana- 
densis and Trivialis, growing in North America. It contains about 12 per 
cent, tannic acid and a bitter principle villosin. 

Fluidextractum Rubi (U.S.P.). Dose: — 2.0-8.0 c.c. Average (U.S.P.), 
1.0 c.c. 

Rhus Glabra (U.S.P.), sumach, the fruit of Rhus Glabra growing in 
North America and containing 5 to 25 per cent, tannic acid. 

Fluidextractum Rhois Glabrae (U.S. P.). Dose: — 1.0-4.0 c.c. Average 
(U.S.P.), 1.0 c.c. 

WORM REMEDIES. 

Although many substances which have been and are used to 
free the body of intestinal worms are not described in this section, 
yet we characterize the following two groups as those of anthel- 
mintics or of worm remedies: they include the typical ones 
which are employed for no other purpose in medicine. Chloro- 
form, salt, turpentine, oil of tansy, quassia and thymol are all 
used as anthelmintics, but they have other qualities and a typical 
action which place them in other divisions. On the other hand, 
male fern, pomegranate and santonica contain active prin- 
ciples whose action is not typical of any other group, and their ex- 
clusive use in therapeutics is as worm remedies. 

The members of these groups are used both against the round 
and tape worms. The action of the drugs depends, in some cases, 
on a specific poisonous action towards the parasites, as with 
pelletierine, which destroys tape worm in a watery solution of 
1 to 10,000. With others, such as male fern, the results are due 



l8o LOCAL ORGANIC DRUGS. 

to the fact that the active principle is absorbed with great diffi- 
culty by the gastro-intestinal tract, much more slowly absorbed 
than by the worm, the latter, therefore, becoming destroyed long 
before poisonous symptoms arise in the afflicted individual. 

When the worm remedies are given to a human being, occa- 
sionally it happens that the conditions are more than usually 
favorable for absorption, either they have been administered 
with a solvent drug or retained too long in the bowels, then 
well-marked poisonous symptoms may develop. Oil helps the 
solution and absorption of many of the anthelmintics, therefore 
such symptoms are especially apt to occur when an oil has been 
given with or after a worm remedy. 

These anthelmintics have more or less selective action for the 
kind of worm: e. g., pelletierine and filicic acid act far more 
energetically on tape worms than santonine, while the reverse is 
true for round worms. 

Formerly anthelmintics were classified as vermifuges, i. e., 
those which drove the worm from the small into the large intes- 
tine, from which it was subsequently expelled, and vermicides, 
i. e., those which killed the parasite. Whether the worms are. 
killed or only sickened depends greatly upon the dose used, and 
upon the condition of the intestines, such as the presence of food, 
which has a tendency to protect the parasite; therefore this 
classification is a little too arbitrary. 

GROUP OF PELLETIERINE. 

Pomegranate, the typical tape worm remedy, contains besides 
tannin a number of closely related alkaloids, the principal ones 
being pelletierine or punicine and isopelletierine. Preparations 
of the crude drug are strongly irritant because of the large amount 
of tannic acid which they contain. 

The active principles of the plant are the alkaloids, one of 
these, PELLETIERINE, being able to kill tape worms in the 
strength of i to 10,000, while it does not affect round worms in 
much stronger solutions. 

When administered to human beings in too large doses, pelle- 



WORM REMEDIES. l8l 

tierine, but more especially crude preparations of the mother 
substance, pomegranate, are liable to produce much irritation 
of the gastro-intestinal tract, evidenced by pain in the abdo- 
men, nausea, vomiting and diarrhoea. Besides the intestinal 
irritation there also occur some symptoms referable to an action 
on the central nervous system, such as headache, dizziness, 
disturbances of cerebration and vision, irritability, tremors, 
cramps in the limbs and even convulsions. 

In frogs, pelletierine decreases the power of relaxation of 
skeletal muscles similarly to vera trine. It increases the reflex 
irritability of the cord which may lead to convulsions, but with 
very large doses it paralyzes the motor nerve endings just as 
curare. 

Warm-blooded animals are not deeply susceptible to pelle- 
tierine, in fact, rabbits require almost 0.3 G. per kilo of their 
body weight to produce fatal results. With large doses, they 
exhibit an increased reflex irritability due to stimulation of the 
cord, and incoordination of movements probably caused by an 
action upon the cerebellum. Death results from paralysis of 
the centres in the medulla, and is, therefore, preceded by de- 
creased respiration and by a fall of blood pressure. 

When extract of ASPIDIUM or male fern is administered to a 
human being suffering from tape worm, as a rule no other symp- 
tom is observed except the poisoned or the dead worm in the 
stool which follows. When, however, too large quantities are 
used or when castor oil or other substances which aid the absorp- 
tion of the poison have been administered, there may occur a 
series of poisonous symptoms, partly referable to gastro-intesti- 
nal disturbances and partly to an effect upon the central nervous 
system. These consist of nausea, vomiting, pain in the abdo- 
men and diarrhoea, dizziness, headache, roaring in the ears, 
dimness of vision, muscular twitching, convulsions, weak pulse, 
superficial respiration, cyanosis, stupor, unconsciousness and 
death. At autopsy the inflammation of the stomach and intes- 
tines is always well marked and occasionally jaundice has been 
observed, probably from the destruction of the red blood cor- 



152 LOCAL ORGANIC DRUGS. 

puscles. The temporary and permanent blindness which has 
occurred in a few cases was possibly the result of degeneration 
of the retina, because such changes can be produced in dogs by 
male fern. 

Of the various substances present in male fern, including resins, 
oils, neutral and acid bodies, etc., the most poisonous, which 
has the same action as extracts of the plant, is FILICIC ACID, 
or filicin. This acid is more poisonous to Taenias and Anchy- 
lostoma Duodenale than to other varieties of worms. It is, as a 
rule, very difficultly absorbed by the gastro-intestinal tract, al- 
though a few fatal cases of poisoning in man are probably due to 
its passage into the circulation. 

In warm-blooded animals, filicic acid depresses the medulla 
at the same time that it increases the reflex irritability of the 
cord. Marked tetanic convulsions like those produced by 
strychnine may be observed. The paralysis of the medulla 
causes a fall of blood pressure and a decrease in the respiratory 
capacity. The heart is also paralyzed by this drug, so that death 
is due to both failure of respiration and circulation. 

There is severe gastro-intestinal inflammation just as after the 
crude drug. The urine of rabbits may show evidence of irrita- 
tion of the kidneys and also glycuronic acid. In frogs, it causes 
a marked weakening of the strength of both skeletal and cardiac 
muscles and general paralysis of the central nervous system. 

ASPIDIN, another constituent of male fern, does not produce 
poisoning in warm-blooded animals when taken internally or sub- 
cutaneously, but produces death by paralysis of the respiratory 
centre when injected intravenously. In frogs it causes much, 
the same symptoms as filicic acid, but is more apt to produce 
twitchings and convulsions; while aspidinin has the same ac- 
tion, albaspidin gives rise to general paralysis like filicic acid. 

Cusso, the Abyssinian anthelmintic, contains as an active 
principle KOSSOTOXIN. This drug has a bitter and disagree- 
able taste which is apt to cause nausea. The symptoms of 
poisoning in man, which are rarely observed, resemble closely 
those seen after an overdose of male fern, and consist of gastro- 



WORM REMEDIES. 1 83 

intestinal irritation with abdominal pain, vomiting and defeca- 
tion, and of depression of the central nervous system with weak, 
hurried respirations and collapse. 

In frogs kossotoxin paralyzes the motor nerve endings, 
the skeletal and heart muscles. It produces convulsions after 
intravenous injection in rabbits. As it depresses the medulla, 
death is the result of respiratory arrest. 

KAMALA is used in the Philippines and India as an anthel- 
mintic. It is said to be less powerful than those previously men- 
tioned. It produces considerable gastro-intestinal irritation re- 
sulting occasionally in vomiting, but more often in evacuation of 
the bowels. 

PEPO or pumpkin seeds are employed in the United States 
for the removal of tape worm, but even in large doses they pro- 
duce no pharmacological action upon animals. 



GROUP OF SANTONIN. 

SANTONIN is the remedy par excellence for round worms, 
which it poisons but does not kill. When these are exposed 
to solutions of santonin, they make lively convulsive movements, 
but do not die. It is possible that santonin may be so trans- 
formed by digestive juices as to be more active within the 
body, yet it is sufficient to assume that the worms made ill in the 
small, take refuge in the large intestine, where, because of their 
disability, they are easily expelled by purgatives. Frequently 
they leave the body in a state of active movements. 

Although santonin is almost insoluble in water, it is to some 
extent dissolved by the juices of the alimentary canal and is* 
partly absorbed, so that even after small doses there is seen in 
man disturbances of vision, and all objects look violet, then 
yellow. It is interesting to note that santonin is a derivative of 
naphthalene, which also produces disturbances of vision. 

Large doses cause the following symptoms : nausea and vomit- 
ing, diarrhoea, headache, haUucinations, dizziness, tremor, con- 
vulsions, involuntary urination and defecation, albuminuria and 



1 84 LOCAL ORGANIC DRUGS. 

hematuria, unconsciousness and death from failure of respira- 
tion. It is believed that the convulsions are due to stimulation 
of the middle brain and later of the medulla. Extremely large 
doses also stimulate the cord. The respiratory and vasomotor 
centres are only depressed late in the poisoning. Santonin 
is excreted partly by the urine and feces in the form of santogenin, 
which colors these secretions a deep saffron color. 

SPIGELIA, another round worm remedy, rarely produces the 
following poisonous symptoms : flushes and dryness of the skin, 
hallucinations, somnolence and disturbances of vision. When 
administered subcutaneously to the lower animals, there occur 
vomiting, incoordinate gait, labored breathing, coma and death, 
which is due to respiratory failure, often preceded by convulsive 
attacks. 

SUMMARY OF GROUP ACTION.— Either special toxic prop- 
erties towards intestinal parasites or difficult absorption by the 
gastro-intestinal tract permits of the uses of quite poisonous sub- 
stances to kill or expel intestinal worms without harm to the host. 
Occasionally with too large doses or when absorption is favored, toxic 
symptoms may arise in man, which consist of gastro-intestinal 
disturbances and stimulation of certain parts of the central nervous 
system, followed by paralysis and death due to depression of the 
respiratory centre. 

THERAPEUTIC APPLICATION.— The substances of the 
Pelletierine group are employed almost exclusively to remove 
tape worms from the gastro-intestinal tract. In order that an an- 
thelmintic may act successfully, it is necessary that the patient be 
properly prepared. This preparation should begin with the 
administration of a cathartic and starvation of the patient for 
twelve to twenty-four hours. The evening before the anthel- 
mintic is to be given, the patient is to eat a little meat well spiced, 
and with onions. Under these conditions the intestinal tract 
will be almost empty, so that the worm cannot protect itself 
in a mass of feces, and the spices and onions will stir up the parasite 
and thus prevent him from hiding in the rugae of the intestines. 
Thus prepared, the anthelmintic is administered in the morning, 



WORM REMEDIES. 1 85 

followed in a few hours by a purge The cathartic should not be 
an oil, as these tend to favor the absorption of the remedies. If the 
treatment has been successful, the worm with head will be 
found in the feces. If the head is not found, the treatment can 
be repeated in one to two weeks, and best when segments of the 
worm begin to appear in the feces. The most commonly used 
tape worm remedies are pelletierine and male fern. 

In order to rid the system of round worms, the same principle 
should be employed as with tape worms, i. e., to leave as little 
residue before the drug is administered as possible, so that it may 
come into more intimate contact with the parasites. Since round 
worms occur more frequently in children, and as santonin, 
the best remedy for these, produces disturbances of vision, it is 
customary to administer the latter at night in order that the child 
may not be frightened by the coloration of his vision. 

MATERIA MEDICA. 
Tape Worm Remedies. 

Aspidium (U.S. P.), Filix Mas (B.P.), male fern, the rhizome of Dry- 
opteris or Aspidium Filix Mas which grows in .America, Asia, Europe and 
Africa. The main active principle is probably filicic acid, but besides this 
there are present the neutral bodies aspidin, albaspidin, aspidinin and a 
fixed oil aspidinol. 

Oleoresina Aspidii (U.S. P.) Dose: — 2.0-4.0 G. Average (U.S.P.), 
2.0 G. 

Acidum Filicicum Amorphum, white yellowish powder soluble in 
cold alcohol. Dose : — 0.5-1.0 G., given with calomel. 

Filmaron, mixture of active principle of male fern occurring in a 10% 
oily solution under the name of nlmaron oil. Dose of latter 10 c.c. 

Extractum Filicis Liquidum (B.P.). Dose: — 45-90 tt^. 

Granatum (U.S. P.), Granati Cortex (B.P.). Pomegranate Bark, the 
bark of the stems and roots of Punica Granatum which grows in the United 
States and Asia and contains the active alkaloids pelletierine and isopelle- 
tierine. 

Decoctum Granati Corticis (B.P.). Dose: — >2-2 fl. §• 

Pelletierine. Colorless, oily, aromatic alkaloid, soluble in water, 
alcohol, ether and chloroform, related chemically to atropine. 

Pelletierinae T annas, insoluble, tasteless powder. Best preparation 
because of its insolubility and difficult absorption. Dose: — 0.2-1.0 G. 
Average (U.S.P.), 0.25 G.' 

Cusso (U.S. P., B.P.) (Kousso or Brayera), female inflorescence of Hagenia 
Abyssinica, a plant native of Abyssinia. It contains a yellow, amorphous 
active body kossotoxin and a resinous decomposition product of the latter. 
kossin. Dose: — Average (U.S. P.), 16.0 G. 

Fluidextractum Cusso. Dose: — 5.0-15.0. 



1 86 LOCAL ORGANIC DRUGS. 

Kamala (U.S. P.), or Rottlera, is a brown powder, consisting of the hair 
and glands of capsule of the fruit of Mallotus Philippinensis, a plant grow- 
ing in the Philippines, China and India. It contains two neutral bodies, 
rottlerin or mallotoxin and kamalin. Dose of Kamala powder, 5.0-10.0. 

Pepo (U.S. P.), seed of Cucurbita Pepo or pumpkin. It contains a large 
quantity of a reddish, fixed oil and also a resin. Powdered seeds are made 
into a meal. Dose : — 30-50 G. 

Round Worm Remedies. 

Santonica (U.S. P.), Levant Wormseed, the unexpanded flower heads of 
Artemisia Pauciflora, native of Turkestan and contain santonin. 

Santoninum (U.S.P., B.P.), colorless to slightly yellow neutral body, 
almost insoluble in water, more soluble in alcohol. Dose: — 0.03-0.1 G. 
Br. (>2-2 grains). 

Trochisci Santonini (U.S.P.), each containing 0.03. Dose : — 1-3 troches. 

Spigelia (U.S.P.), the rhizome and roots of Spigelia Marylandica, native 
of the United States and contains a volatile alkaloid, spigeline. 

Fluidextractum Spigelian (U.S.P.). Dose: — 1.0-8.0. Average (U.S. P.), 
4.0 c.c. 

Chenopodium, American wormseed, the fruit of Chenopodium Am- 
brosioides which grows in the United States and West Indies, and con- 
tains as active principle a volatile oil. It is used for the same purposes as 
santonin. 

Oleum Chenopodii (U.S.P.), volatile oil, thin, colorless with a camphorous 
odor and pungent bitter taste. Dose: — 0.1-0.5. Average (U.S. P.), 0.2 
c.c. 

GROUP OF MECHANICAL AGENTS. 

The following is a list of substances which are used either for 
their physical effects in the preparation of active drugs, or for 
their physical action on some portion of the organism. 

Thus the gums, such as acacia, chondrus, althaea and traga- 
canth, are employed to increase the viscosity of fluid vehicles in 
order to keep in suspension insoluble substances. 

The oils and fats are used to soften the skin, to protect it from 
the action of air, and to introduce remedies either for it or for the 
general organisms which are to be absorbed by the skin. 

Other substances used to bring remedies in contact with the 
skin are cotton or solutions of collodion and of gutta percha. 

Such substances as sugar, saccharin, rose, melissa, vanilla, rasp- 
berries or bayberries are employed to sweeten or flavor medicinal 
substances or foods. 

On the other hand, mulberry juice, saffron and caramel serve 
to color medicinal preparations. 



MECHANICAL AGENTS. 1 87 

MATERIA MEDICA. 

Acacia (U.S. P.), Acacias Gummi (B.P.), or Gum Arabic, gummy exudate 
from the stem and branches of Acacia Senegal growing in Africa and India. 
It is composed of whitish opaque masses which fracture like glass, soluble 
in 2 parts of water, insoluble in alcohol. 

Mucilago Acaciae (U.S. P., B.P.) contains 34 per cent, of gum acacia. 

Syrupus Acaciae (U.S. P.), contains 25 per cent, of the mucilage. 

Chondrus (U.S. P.) (Irish moss), an algae growing on the coast of Ireland 
and New England. It is composed of dark, purplish, gristly weeds. 

Agar-agar, Chinese gelatine or isinglass. It belongs to the same family 
as the above. It is entirely unabsorbed in the gastro-intestinal tract and 
has the property of retaining much water. On account of these properties, 
it has been used with much success in cases of constipation due to too great 
inspiration of the stools. It is either given plain or in the form of the trade 
preparation "Regulin" mixed with cereals, apple sauce, soup, etc., at meals. 

Althaea (U.S. P.), marshmallow, root of Althaea officinalis. 

Syrupus Althaeae. 

Ulmus (U.S. P.) or slippery elm, the inner bark of Ulmus Fulva. 

Mucilago Ulmi. 

Tragacanth (U.S.P.,B.P.), gummy exudation from Astragalus Gummifer. 

Mucilago Tragacanthi (U.S. P., B.P.) contains 6 per cent. 

Oleum Olivae (U.S.P., B.P.), oil expressed from the fruits of Olea Euro- 
paea or olives. It is used not only extensively as a food, but as a fattening 
agent and gentle laxative. 

Sapo (U.S.P.), Sapo Durus (B.P.), sodium oleate, made by boning olive 
oil with caustic soda. It is the hard Castile soap. 

Emplastrum Saponis (U.S. P., B.P.), 10 per cent, soap with lead plaster. 

Linimentum Saponis (U.S.P.) (liquid opodeldoc) contains camphor, 
alcohol, soap, oil of rosemary and water. 

Oleum Lini (U.S.P., B.P.), or linseed oil, expressed from the seeds of 
Linum Usitatissimum. 

Sapo Mollis (U.S.P. , B.P.), or soft soap, made by boning linseed oil 
with caustic potash, and is a soft, brown, yellowish unctuous mass. 

Linimentum Saponis Viridis (U.S.P.), contains soft soap, alcohol and oil 
of lavender. 

Linimentum Calcis (U.S.P.) contains olive oil and lime water or carron oil. 

Oleum Gossypii Seminis (U.S.P.), or cotton seed oil. 

Oleum Amygdalae Expressum (U.S.P.), Oleum Amygdalae (B.P.), or 
oil expressed from the seeds of Amygdalum Communis Dulcis or sweet 
almonds. 

Emulsum Amygdalae (U.S.P.), 6 per cent, emulsion of almond with sugar 
and water. 

Oleum Theobromatis (U.S.P., B.P.), or cocoa butter, present in the 
quantity of 50 per cent, in the seeds of the Theobroma Cacao. It is a neutral 
fat with the odor of chocolate, solid at the temperature of the room, but 
liquid at the temperature of the body, therefore applicable for the introduc- 
tion of remedial agents into external cavities of the body, such as the rectum, 
vagina or urethra. 

Oleum Chaulmoograe, thick brown oil with nauseating odor and taste, 
obtained from the seeds of Gynocardia odorata. It contains free gyno- 
cardic and palmitic acids. Used in the treatment of leprosy both internally 



1 88 LOCAL ORGANIC DRUGS. 

and externally. Dose : — Begin with 5 drops and increase to 200 drops 3 to 
4 times daily. 

Cetaceum (U.S.P., B.P.), or spermaceti, fat extracted from a pocket in 
the upper jaw of the whale Physeter macrocephalus. 

Ceratum Cetacei (U.S.P.) contains 10 grammes of cetaceum to 35 
grammes of wax and 55 grammes of olive oil. 

Adeps (U.S. P., B.P.), or lard, fat extracted from hogs. 

Adeps Benzoinatus (U.S.P.) , Adeps Benzoatus (B.P.), lard containing 
2 per cent, benzoin. 

Ceratum (U.S.P.), lard containing 30 per cent, of wax. 

Unguentum (U.S.P.), common ointment, lard containing 20 per cent, of 
wax. 

Unguentum Aquae Rosa? (U.S.P., B.P.) contains 12^ per cent, of 
cetaceum. 

Oleum Adipis (U.S.P.), oil of lard. 

Acidum Oleicum, obtained by the saponification of oil of almonds or 
of olives. It is a clear, colorless, syrupy liquid used as a solvent for medi- 
cine. 

Glycerinum (U.S.P., B.P.), triatomic alcohol obtained by the saponifi- 
cation of neutral fats. It is a clear, colorless, odorless, syrupy liquid, with a 
sweet taste. 

Petrolatum, soft paraffin or vaselin, a mixture of hydrocarbons from 
petroleum. Melting point 45-48 C, used as an emollient and base for 
ointments. 

Petrolatum Album, white petrolatum. 

Petrolatum Liquidum, colorless liquid insoluble in H 2 0, alcohol; 
soluble in oils and oil-soluble solvents. Used as a vehicle for sprays, etc. 

Gossypium Purificatum (U.S.P., B.P.), the hairs of the seed of Gossyp- 
ium Herbaceum, or cotton, which is washed to remove the oil. Used in 
surgical dressings. 

Pyroxylinum '{U.S.P.. B.P.), or gun cotton, made by nitrifying cellulose. 

Collodium (U.S.P., B.P.), solution of gun cotton in 3 parts of ether and 
1 part of alcohol. Used to cover cuts or to apply remedial agents to the skin. 

Collodium Flexile (U.S.P., B.P.), or flexible collodion, same as the above 
with the addition of turpentine and cotton seed oil. 

Collodium Stypticum, collodium containing 25 per cent, tannic acid. 

Carbo Ligni (U.S.P., B.P.) (charcoal), made by heating soft wood to a 
red heat without air. Absorbs gases. 

Carbo Animalis (U.S.P.) (animal charcoal), made by burning bones 
in the exclusion of air. 

Carbo Animalis Purificatus (U.S.P.) (purified animal charcoal), made by 
boiling animal charcoal with hydrochloric acid. 

Elastica (U.S.P.), Caoutchouc (B.P.), milky juice from Hevea Brasiliensis 
or India rubber. It hardens to black balls or cakes, soluble in chloroform, 
carbon disulphide and benzine. 

Liquor Caoutchouc (B.P.) is a 5 per cent, chloroform solution of rubber. 

Gutta Percha, exudation from Palaquium Gutta, a plant growing in 
the Malay Islands. 

Liquor Gutta Percha, 9 per cent, solution of gutta percha and chloroform. 

Ichthyocolla (U.S.P.), the dried swimming bladders of Acipenser Huso. 

Emplastrum Ichthyocollse (U.S.P.), or court plaster, consists of cloth 
painted over with a solution of ichthyocolla. 



MECHANICAL AGENTS. 1 89 

Saccharum (U.S. P.), Saccharum Purificatum (B.P.), or cane sugar, 
white, crystalline body, soluble in water, insoluble in alcohol. 

Syrupus (U.S.P., B.P.), 65 per cent, solution of cane sugar. 

Saccharum Lactis (U.S. P., B.P.), or lactose, or milk sugar. White 
crystalline body, soluble in water. 

Mel Despumatum (U.S.P.), Mel Despuratum (B.P.), clarified honey. 

Saccharinum, or benzoic sulphinide, a coal tar derivative consisting 
of white crystals, soluble in alcohol, ether and glycerine, only soluble in 
400 parts of water. It is 280 times sweeter than cane sugar. It is used to 
sweeten the food of diabetics. Dose: — 0.05 to 0.2 G. 

Rosa Gallica (U.S. P.), petals of a species of red rose. 

Confectio Rosae (U.S. P.) contains 8 per cent, rose, besides sugar, honey 
and rose water. 

Oleum Rosae (U.S. P., B.P.), or attar of rose, pale yellow transparent 
ethereal oil obtained by the distillation of Rosa Damascus. 

Aquae Rosae (U.S. P., B.P.) is a saturated, watery solution of oil of rose. 

Melissa Officinalis (U.S.P.), a perennial herb growing in Asia Minor 
and Southern Europe. Contains a volatile oil. 

Spiritus Melissae. 

Vanilla (U.S. P.), dark, green climber growing in Mexico and South 
America and contains the neutral principle vanillin which is a white, crystal- 
line body soluble in ether and alcohol. It can be made artificially from 
coniferine of pines. 

Vanillin. Dose: — 0.01 to 0.02 G. 

Tinctura Vanillae contains 10 per cent, of the fruit. 

Syrupus Rubi Idaei, 40 per cent, of the juice of rubus idaeus or raspberry. 

Myrcia or bayberry contains the bay oil. 

Spiritus Myrciae or bay rum. 

Succus Mori, mulberry juice. 

Syrupus Mori. 

Crocus Sativa, or saffron. 

Tinctura Croci. 

Lycopodium, Spores of Lycopodium, yellow powder used for sprinkling 
pills. 

Amylum, a starch, white powder. 

Kaolin, aluminum silicate, insoluble, used as dusting powder. 

Talcum, magnesium silicate, insoluble dusting powder. 



PART IV 



INORGANIC DRUGS. 

Like the organic drugs, the inorganic have both a local and 
a general action. Although little is known about the manner in 
which both act, yet with the inorganic we may more frequently 
observe simpler actions in which we can clearly see a physical 
process or a fairly simple chemical reaction; thus may be men- 
tioned the "salt action" of sodium chloride on the metabolism, 
explained by the changing of osmotic tension of the body fluids ; 
the carbonizing effect of sulphuric acid by drawing the water out 
of the tissues, the local caustic effects of oxidizing agents, free 
halogens, the alkalies, acids and soluble metals in proper concen- 
tration due to the chemical compounds formed between these and 
the proteids of the cells, thus destroying the vitality of the proto- 
plasm. Another example is the acid intoxication seen in her- 
bivora after feeding on mineral acids. The latter combine with 
the alkalies in the blood and leave none for the absorption of 
carbonic acid and the carrying on of internal respiration. 



OXIDIZING AGENTS AND FREE HALOGENS. 

The local effect is the striking feature and with both oxygen- 
liberating substances and free halogens there is an oxidation of 
the living tissues. Halogens combine with the proteids first, but 
ultimately oxidize and destroy them, just as the pure oxidizing 
agents. Thus in chemistry we sometimes use for the oxidation 
of organic matter potassium permanganate or potassium chlorate 
interchangeably. 

191 



192 INORGANIC DRUGS. 

GROUP OF OXYGEN. 

This group contains oxygen itself and various substances which 
liberate oxygen when in contact with organic tissues, such as 
hydrogen peroxide, potassium permanganate, chromic acid, etc., 
but with all of these except oxygen itself, oxidation takes place 
only at the site of application, and therefore these oxidizing sub- 
stances are rather to be considered as local disinfectants, irritants 
and caustics, than as drugs influencing the internal oxidations. 

OXYGEN is absorbed from the air by the alveoli of the lungs. 
After its absorption it goes into a definite chemical combination 
with haemoglobin and only an insignificant portion is dissolved 
in the serum under normal atmospheric pressure. On account 
of these facts, its absorption and excretion do not follow the laws 
of partial tension. The increase or diminution of oxygen in 
the body, under normal atmospheric pressure, is almost exclu- 
sively affected by the increase and diminution of haemoglobin, 
by the amount of available breathing space in the lung and by the 
efficiency of the circulation. All conditions being equal, no more 
oxygen is taken up by the haemoglobin when pure oxygen is re- 
spired than when ordinary air containing 20 per cent, is breathed. 
On the other hand, with pure oxygen, the rate of diffusion and 
absorption being increased, the respiratory frequency is de- 
creased. 

Under normal atmospheric pressure the inhaling of undiluted 
oxygen increases the quantity of the same dissolved in the plasma 
from the normal 0.6 per cent, to 3 per cent. When it is adminis- 
tered under increased pressure, the augmentation in the quantity 
dissolved in the serum may be sufficient so that this portion alone 
is capable of maintaining life, if the pressure is high enough. 

OZONE is a much more active oxidizing agent than oxygen. 
It is a powerful irritant and disinfectant. When breathed, it pro- 
duces severe irritation of the respiratory passages, being cap- 
able of causing death by inflammation of the lungs. The quan- 
tity present at times in air is, however, too slight to produce any 
symptoms. 



GROUP OF OXYGEN. 1 93 

HYDROGEN PEROXIDE liberates oxygen slowly in the 
air, but rapidly when in the presence of animal or vegetable tis- 
sues, such as blood, various organs, pus, bacteria, etc. Because of 
this oxygen it is a strong oxidizing agent and, therefore, a dis- 
infectant because it destroys the bacteria and the food on which 
they live. 

When hydrogen peroxide is applied to a mucous membrane 
or to a wound, especially when blood or pus is present, it foams 
violently and produces a burning sensation. The oxygen thus 
liberated is not appreciably absorbed by the circulation, so that 
the internal administration of hydrogen peroxide cannot increase 
the oxygen in the blood. If introduced intravenously, or sub- 
cutaneously, or into serous cavities, it may produce oxygen 
emboli in the circulation with fatal consequences. 

Lately there have been introduced a number of other inor- 
ganic peroxides, as those of sodium, magnesium and zinc, 
also the organic benzoyl acetyl peroxide. These do not give 
up their oxygen as readily as hydrogen peroxide, yet have quite 
well-marked disinfectant properties. 

POTASSIUM PERMANGANATE also liberates nascent oxy- 
gen when in contact with organic tissues. Because of this nascent 
oxygen which combines with the proteids, it acts in strong solu- 
tions as a caustic, especially over raw surfaces and mucous 
membranes, and in dilute solutions as an irritant. The lower 
fungi or bacteria are killed and therefore it is an antiseptic. 
Its effect is very superficial because it becomes reduced to an 
inactive state before it can penetrate deeply into the* tissues. For 
this reason it cannot increase the oxygen contents of the blood 
or act in the circulation as a disinfectant, as it is destroyed by 
reduction before it is absorbed. Although recommended to 
destroy poisons in the stomach and intestines, it has little such 
action, for it loses its activity in contact with the mucous mem- 
branes lining the canal leading to the gastro-intestinal tract. 

When taken internally in sufficient quantities, the symptoms 
of poisoning consist of those of gastro-enteritis, such as nausea, 
vomiting, diarrhoea and collapse. When locally applied, it stains 
13 



194 INORGANIC DRUGS. 

the skin brown because of the reduction of the permanganate to 
the black oxide of manganese. This discoloration can be easily 
removed by washing with a solution of oxalic acid. 

CHROMIC ACID and POTASSIUM BICHROMATE in com- 
mon with other substances of this group easily give up nascent 
oxygen to organic tissues, but in addition they have a constitu- 
tional action due to the metal chromium. Chromic acid is 
especially caustic because its oxidizing properties are reinforced 
by its acid constitution. Both the bichromate and the acid act 
as irritants and antiseptics, and in solutions of great concen- 
tration, as caustics. Their corroding effect is great, but less 
painful than that of most other caustics, although they are some- 
times dangerous from the extreme poisonous effect of chromium 
after absorption. 

The symptoms of poisoning consist of diarrhoea, vomiting, 
albuminuria, hematuria, fall of blood pressure, muscular twitch- 
ing and even convulsions. On pathological examination, there 
is great congestion of the gastro-intestinal tract, frequently ac- 
companied by ecchymoses and ulcerations. The kidneys are in a 
state of acute nephritis. The symptoms referable to the gas- 
tro-intestinal tract and kidneys are due to the fact that chromium 
is excreted by these organs, mainly by the latter. Chronic poi- 
soning occurs in factories, and consists of ulcerations in the nose 
and ears, chronic inflammation of the larynx and pharynx, due 
to the inhalation of chromate dust. When given to animals over 
a space of time, they may produce chronic interstitial nephritis. 

SUMMARY OF GROUP ACTION.— Oxygen normally acts as 
the oxidizer of food stuffs to furnish heat and force. It cannot be 
increased in the blood by increasing its concentration in the air 
unless the atmospheric pressure is also increased. Only a decrease 
in the rate of respiration occurs when more concentrated oxygen 
is inhaled. The other members, as Hydrogen Peroxide, Potassium 
Permanganate, etc., have no effect on internal respiration, but act 
only locally as oxidizing agents, disinfectants, irritants and caustics. 

THERAPEUTIC APPLICATION.— Pure oxygen is used in 
medicine in diseases of the respiratory tract attended by dimin- 



GROUP OF OXYGEN. 1 95 

ished lung capacity, as in pneumonia or phthisis, also in extreme 
dyspnoea from cardiac insufficiency. Its good effect, if any, in 
these cases is to be referred to the diminution of the dyspnoea of 
the patient on account of the more rapid rate of absorption of 
oxygen. The latter is used mixed with ancesthetics in order to 
diminish danger from asphyxia. It might be useful in cases of 
poisoning with carbon monoxide and the poisons which produce 
methaemoglobinaenra, if given under sufficient pressure to dis- 
solve 20 per cent, in the plasma and replace the functions of the 
crippled haemoglobin. Hydrogen peroxide is used in a 3 per 
cent, solution as a disinfectant and to cleanse wounds. It should 
never be injected into closed cavities without outlet, or into blood 
vessels, on account of the danger of local pressure in one case 
and formation of emboli in the other. 

Potassium permanganate is also used as a disinfectant for 
washing surgeons' hands, for irrigating infected canals or cavities, 
as in gonorrheal urethritis and vaginitis, and in diseases of the 
mouth and rectum. This substance and hydrogen peroxide 
have been used in the past subcutaneously or internally in cases 
of poisoning with the hope that the poison might be more rapidly 
oxidized. The fallacy of this administration is obvious from the 
pharmacological action. It may, however, be of value when in- 
jected around and in the site of a snake bite, also when the wound 
is enlarged surgically and washed with strong permanganate 
solutions. 

Chromic acid, in concentrated form, is used mainly as a 
local caustic to burn off new growths, etc. In dilute solutions 
this acid and the bichromate of potassium are sometimes em- 
ployed as disinfectants. 

MATERIA MEDICA. 

Aqua Hydrogenii Dioxidi (U.S. P.), Liquor Hydrogenii Peroxidi (B.P.), 
is a 3 per cent, solution of hydrogen dioxide in water. It is a colorless, 
odorless, acid liquid which foams when in contact with pus or other organic 
material. Used as a disinfectant wash for wounds or external cavities of 
the body, such as the mouth. Dose : — Average (U.S.P.), 4.0 c.c. 

Potassium Permanganas (U.S.P., B.P.) is composed of small purplish 
crystals with a sweetish, astringent taste, soluble in 16 parts of water. It 
imparts to water even in very dilute solutions a deep pink or red color. It 



I.96 INORGANIC DRUGS. 

easily liberates oxygen when in contact with organic material. Dose: — 
0.05 to 0.2 G. Br. (1-3 grains). Average (U.S.P.), 0.065. 

Acidum Chromicum (B.P.), dark red crystals, very lustrous and de- 
liquescent, soluble in 10 parts of water. It oxidizes organic material with 
readiness. Used externally as a caustic. 

Potassii Bichromas (B.P.), large, orange red crystals having a bitter 
metallic taste, soluble in 10 parts of water. Dose : — 0.005 to °- 01 G. Br. 
(tW grain). Average (U.S.P.), 0.01 G. 



GROUP OF FREE HALOGENS. 

This group comprises the free halogens, Chlorine, Bromine, 
Iodine, and those compounds of these from which they are easily 
liberated in the free state. 

The free halogens form insoluble compounds with proteids 
which later become dissolved and destroyed. Their effects on the 
latter may be explained firstly by their entering the proteid mole- 
cule, secondly by withdrawing hydrogen to form an acid, and 
lastly by breaking up the water in the tissues and forming nascent 
oxygen. On account of this action they act as irritants, caustics 
and disinfectants. These properties are most marked with chlor- 
ine, less marked with bromine, still milder with iodine. 

When CHLORINE is kept on the skin the destruction is terrific, 
but it is as well marked with BROMINE ; the latter being a liquid, 
remains longer in contact with the tissues and penetrates deeply 
into these, thus in a few minutes after application the most wide- 
spread destruction of living matter may take place and the ulcers 
left by this corrosion are always slow to heal, probably because 
the disabling effect reaches into the remaining living tissues. 
IODINE is much less caustic, and even in ten per cent, solution 
on the skin it only causes a little burning and itching, but when 
the brown color of the iodine disappears the skin usually looks 
red and peels. Strong solutions may act as a caustic on mucous 
membranes and always produce an inflammatory reaction. 

Chlorine gas, by combining with hydrogen sulphide and am- 
monia, destroys the odor of these and of other bad-smelling gases ; 
thus it acts as a deodorizer. 

When chlorine and bromine vapors are breathed they produce 



GROUP OF FREE HALOGENS. 1 97 

severe irritation of the eyes, nose and throat, bronchi and lungs, 
which may well result fatally from oedema of the larynx or pneu- 
monic inflammation. Even small quantities, as one part of 
chlorine and bromine in a million of air, produce terrible burning 
pain in the eyes, nose, throat and chest, with sneezing and violent 
coughing. Severe bronchitis or pneumonia with hemorrhage 
from the lungs are frequent sequels of inhaling the halogen fumes. 
Unconsciousness usually supervenes early. 

When the halogens are taken internally in large quantities, 
death takes place from gastro-enteritis and collapse. They 
produce severe pain in the throat, oesophagus and abdomen, 
with bloody vomiting and diarrhoea if death does not take place 
immediately. If the quantity taken is not sufficient for fatal 
results, they cause ulcerations at the place of contact, especially 
along the oesophagus and stomach. If death does not result 
within a few days from perforation of these ulcers, the latter heal 
with the formation of cicatricial tissue, which in the oesophagus 
or at the openings of the stomach may produce stenosis and oc- 
clude the passage along the gastro-intestinal canal. In case of 
poisoning by swallowing chlorine and bromine, the chemical anti- 
dote is albumin, while with iodine it is starch. 

Chlorine and bromine are said to have specific narcotic 
properties: in factories, workmen poisoned by the halogen 
fumes frequently show symptoms of somnolence and dulled in- 
tellect. The vapors of iodine are also irritant when inhaled, 
but are not so severe as those of chlorine and bromine. The 
quantity of fumes liberated from iodine at the ordinary tempera- 
ture is so small that it takes quite prolonged inhalation to get 
reddening of the eyes, sneezing with watering of the nose, and 
coughing with pain in the chest. When taken by the stomach in 
even small doses, iodine causes vomiting, nausea, often tender- 
ness of the abdomen and diarrhoea. With large quantities, the 
symptoms are those of severe acute gastro-enteritis, as from any 
irritants. The irritation of the gastro-intestinal tract is not only 
observed by internal administration but also after subcutaneous 
application, injections into tumors or sacs, or into the uterus; it 



190 INORGANIC DRUGS. 

may be explained by the excretion of this halogen by the salivary 
glands and stomach. 

Iodine is probably absorbed chiefly as an albuminous com- 
pound : it circulates through the body as such and is excreted in 
main part by the kidneys in the form of iodides. Small amounts, 
however, are excreted by the mouth, upper respiratory tract and 
skin, probably in the form of a loose albuminous compound. 
The irritation of the skin and respiratory passages which occurs 
in iodism can be explained by the liberation of iodine from the 
secretion of these organs. It is also excreted by the stomach in 
the form of hydriodic acid which becomes partly decomposed 
into iodine. 

Occasionally when iodine is given in small doses to a patient 
over a period of time, besides evidences of local irritation there 
is observed a marked change in the metabolism. The patient 
loses weight, his pulse becomes accelerated, he grows very ner- 
vous, irritable and sleepless and may show fine tremors of the 
extremities. These symptoms are the same which may be ob- 
served after an overproduction of thyroid extract or in exoph- 
thalmic goitre and maybe due to the stimulation of that gland, 
which itself contains much iodine. Besides these there may oc- 
cur atrophy of the breasts and testicles, but skin eruptions and 
irritation of the respiratory tract are rare, therefore this form of 
chronic action of iodine is quite different from that of iodides. 

Though rare, even fatal poisoning has resulted after the ab- 
sorption of iodine by cysts. The symptoms were sleepiness, 
thirst, constant vomiting, sensitiveness of the abdomen, cyanosis 
of the cheeks and extremities, small weak pulse, skin eruptions 
and death in a few days. After death in man, the mucous mem- 
brane of the gastro-intestinal tract shows marked inflammation, 
and in animals even fatty degeneration of the parenchymatous 
organs has been observed. 

SUMMARY OF GROUP ACTION.— Local irritants, caustics 
and disinfectants through their action on proteids Poisoning by in- 
halation gives terrific inflammation of the respiratory tract, while 
that by ingestion produces widespread destruction of the alimentary 
canal. 






GROUP OF FREE HALOGENS. 1 99 

THERAPEUTIC APPLICATION.— The use of the halogens in 
medicine is based almost wholly on their local action. Chlorine, 
bromine and iodine in the form of pastes have been used, es- 
pecially by so-called " cancer specialists, " as caustics to burn off 
superficial cancers. Iodine solutions are used as disinfectants 
and astringents in wounds or diseased cavities such as that of the 
uterus, nose and throat; also as local irritants to produce adhe- 
sions of the walls of a hydrocele by inflammatory reactions; also 
employed as counterirritants in painful or inflammatory af- 
fections of the chest and joints. 

Chlorine water and solutions of iodine were formerly used 
internally as disinfectants of the gastro-intestinal tract in such 
infectious conditions as typhoid fever. Nowadays, we still use ex- 
ternally to disinfect wounds the solution of sodium hypochlorite, 
which contains and acts by virtue of its free chlorine. 

Chloride of lime, which gives off chlorine by the influence of 
carbon dioxide, is used as a deodorizer in sick rooms, water closets, 
etc., also as a disinfectant of infectious urines, stools, etc. 

MATERIA MEDICA. 

Aqua Chlori, a clear, greenish-yellow liquid with the suffocating odor of 
chlorine. It is a 0.4 per cent, solution of chlorine gas and water. Dose : — 
5 to 15 c.c. 

Calx Chlorinata (U.S.P., B.P.), or chlorinated lime, or calcium hypo- 
chlorite, is a grayish-white powder with the odor of chlorine. It is gradually 
decomposed by the carbonic acid of the air with the liberation of chlorine. 
It should contain 35 per cent, of available chlorine. 

Liquor Sodae Chlorinatae (U.S. P., B.P.) or Labarraque's solution. It 
is a solution of chlorinated soda containing at least 2^2 per cent, of available 
chlorine and is a pale green liquid with the odor of chlorine. Dose: — 0.5 
to 1 c.c. Br. (3-15 ttr). Average (U.S. P.), 1.0 c.c. 

Bromum (U.S.P.), dark, fuming, brownish-red liquid, soluble in 30 parts 
of water, more readily soluble in water containing potassium bromide. 
Easily soluble in alcohol and ether. 

Iodum (U.S. P., B.P.), heavy bluish crystals with a metallic luster, pene- 
trating odor and burning metallic taste. Soluble in 5,000 parts of water. 
Easily soluble in water containing potassium iodide. Soluble in 10 parts of 
alcohol and freely in ether. 

Tinctura Iodi (U.S.P.), 7 per cent, solution of iodine and alcohol. Dose : 
— 0.1 to 0.5 c.c. Average (U.S. P.), 0.1 c.c. 

Tinctura Iodi (B.P.), 2^ per cent, solution. Dose: — 2-8 tt^. 

Liquor Iodi Compositus (U.S.P.) orLugoPs solution, contains 5 parts of 
iodine, 1.0 of potassium iodide to 100 of water. Dose: — 0.2 to 1.0 c.c. 



200 INORGANIC DRUGS. 

Unguentum Iodi (U.S. P., B.P.) contains 4 per cent, iodine besides 
potassium iodide and benzoinated lard. 

Iodopine, compound of iodine with fats. Used internally in place of 
iodine or iodides. 

Iodoformum (U.S. P., B.P.), yellow crystals, nearly insoluble in water, 
soluble in alcohol, ether and fats, with intensely disagreeable odor. Liberates 
iodine in contact with wounds or fluids of the body. Causes at times after 
absorption from wounds or too large internal doses, delirium and mania and 
even death in collapse. Used as an antiseptic dusting powder, injected in 
oily solution into tuberculous joints, also internally for treatment of syphilis 
on account of its iodine. Dose : — 0.03 to 0.2 G. Average (U.S.P.), 0.25 G. 

Iodoformum Aromatisatum, same as above, flavored with 4% cumarin. 

Iodolum, tetraiodopyrrol, grayish-brown crystals insoluble in water. 
Does not smell as badly as iodoform. Uses and dose same. 



GROUP OF WATER. 

The action of water is complicated by its temperature and 
by the salts which it always contains except when distilled. 

Since three-quarters of the bulk of a living organism is com- 
posed .of water, we would not expect a marked action from the 
administration of small quantities, yet it has certain properties of 
interest. 

Distilled water is an irritant poison. This irritation is pro- 
duced by its power of extracting salts from the living tissues 
with which it comes in contact. In this way small animals, 
amoebae, fish, etc., are killed. It is irritating to sensitive mucous 
membranes, as those of the nose, and also to denuded surfaces. 
Taken over a prolonged period of time, it may produce gastro- 
enteric inflammation, and by diminishing too much the salt 
concentration of the urine, it may even produce irritation of the 
kidneys. It is not absorbed from the unbroken skin. 

Ordinary water is also not absorbed from the unbroken skin. 
After long- continued baths the superficial layers of the epidermis 
may imbibe a small quantity, which, however, does not reach 
the circulation. 

Water is not absorbed from the stomach, but easily so from 
the intestines, and most readily if taken before meals when the 
latter tract contains the least solid material. 

The ingestion of large quantities of water may increase the 



GROUP OF WATER. 201 

number of stools and their watery contents. It increases the 
excretion of urine and often of sweat. 

Inhalation of watery vapors may cause dyspnoea, headaches, 
dizziness, great congestion of the head and even apoplectic at- 
tacks. This action is probably due mainly to reflex stimulation 
of the vasomotor centres by the temperature. 

On account of the increase in absorption and excretion which 
it causes, water augments the interchange of material in the body 
and, therefore, the metabolism. This leads to a greater excretion 
of urea and sulphates. The body learns to accommodate itself 
to the new condition and in a few weeks the nutrition becomes 
normal. 

Mineral waters possess merely the action of ordinary water 
plus that of the salts which they contain. The action of the 
latter will be described in another group. 

THERAPEUTIC APPLICATION.— Water is used externally 
in the form of baths in various skin diseases to soak off scales or 
crusts on the upper layer of the epidermis, and prepare the skin 
for the action of other agents, such as the salts contained in the 
water itself. 

It is used in the form of poultices to soften the epidermis and 
allow the easy escape of pus from an abscess. The heat of 
poultices is also employed as a counterirritant to influence in- 
ternal pain. 

Cold baths, which act by virtue of the temperature, are used 
in various chronic diseases as reflex stimulants of respiration, 
circulation and general metabolism. They are also employed 
in fevers to decrease the body temperature. 

Hot baths are especially useful to produce sweating and rid 
the body of undesirable products, as in Bright's disease, acute 
infections, colds, rheumatism and gout. 

Local hot baths are used on the feet to congest the latter and 
to draw the blood away from inflamed internal organs, as lungs 
or brain. 

Hot sitz baths are used to congest the pelvic organs and 
restore suppressed menstruation. 



202 INORGANIC DRUGS. 

The sweating seen after hot or cold baths is not due to absorp- 
tion of water from the bath, but probably to the hyperemia of 
the skin brought about by the temperature changes and to some 
extent by retention of water in the blood, and inhibition in the 
epidermis during the bath. 

The quieting influence which warm baths have on the central 
nervous system is sometimes used to relieve restlessness, pain 
and muscular spasm. 

Water is used at spas for the treatment of almost every chronic 
disease. Its good effects are probably mainly due to its power 
of increasing general metabolism. It is serviceable as a diuretic 
in kidney disease and to prevent the formation of stones in the 
kidney and bladder. It is also employed in constipation and 
catarrh of the small intestine. 

The quantity of water ingested is restricted in diarrhoea. It 
was formerly decreased in dropsies in order to make the blood 
more concentrated and aid absorption of fluid. By its dimi- 
nution in obesity, the absorption of food may be hindered and 
thus body weight may be reduced. 

Water is used to distend the rectum in the form of clysters 
and thus reflexly produce an emptying of the bowels. The 
drinking of large quantities at one time may, by distending the 
stomach, produce vomiting. 

GROUP OF ACIDS. 

The members of this group are all the inorganic and organic 
acids which act by virtue of their acid structure and properties, 
and not in a specific way as do hydrocyanic and arsenious acids. 
For in the two latter the specific action entirely obscures the 
general acid action. 

The stronger mineral acids, such as sulphuric, hydrochloric, 
nitric and phosphoric precipitate, then destroy proteids in con- 
centrated solutions, but merely dissolve them in dilute ones, forming 
acid albuminates. They change the composition of the tissues of 
the body by withdrawing their water. Concentrated SUL- 



GROUP OF ACIDS. 203 

PHITRIC ACID acts so energetically in this direction that it not 
only removes the preformed water, but breaks up the organic 
material by forming water from the hydrogen and oxygen, leaving 
ultimately nothing but carbon. When applied to the skin, it 
produces at first a white eschar due to precipitated proteid which 
turns black by carbonization. The destructive action of NITRIC 
ACID on proteids is due in good part to the formation of a nitro- 
derivative, xanthoproteic acid, which is later oxidized, when 
complete destruction of the proteids occurs. The eschar on the 
skin is yellow, due to the color of the xanthoproteic acid. HY- 
DROCHLORIC ACID is less likely to cause deep-seated corro- 
sion and attacks chiefly the superficial layers of the skin and raises 
blisters. PHOSPHORIC ACID is a still milder caustic. Most 
organic acids have a mild effect, but some, such as glacial acetic, 
trichloracetic and lactic, have a caustic action, only much 
weaker than the inorganic. All except sulphuric and nitric 
produce a white eschar. With acids, the caustic effect has a 
tendency to limit itself because of the wall of precipitated proteids 
which is formed to check the advance of the agents. This 
makes their local action different from that of the caustic alkalies 
which do not precipitate proteids and have the tendency to 
spread deeper and deeper without limits. 

In dilute solutions the members of this group attack proteid 
substances forming albuminates and thus are irritants and anti- 
septics. The amount of irritation and antiseptic action depends 
upon the strength of the particular acid and its concentration. 
As almost all living tissues have an alkaline reaction, acids de- 
stroy their life and act in a sense as protoplasmic poisons. An 
apparent exception seems to be a few moulds and other lower 
forms which live in acid solutions, e. g., the Sarcinae found in the 
stomach in dilatation of this organ. Most bacteria, however, are 
killed by even as low a concentration as 0.2 per cent, hydrochloric, 
the quantity found in the normal stomach of man. 

The symptoms of acute corrosive poisoning by strong acids 
are those of gastro-enteritis , with intense pain in the mouth, 
oesophagus and stomach, vomiting and often diarrhoea, profound 



204 INORGANIC DRUGS. 

shock, weak pulse and respiration. Death occurs from collapse 
due to the severity of the gastro-intestinal lesion, which, with the 
stronger acids, may amount to perforation. When a patient 
passes the acute attack, he frequently suffers from narrowing 
of various parts of the tract due to cicatricial contraction of 
the ulcers. The treatment of this corrosive poisoning is based on 
the neutralization of the acid by dilute alkalies. Those which of 
themselves are not corrosive and which do not produce gas, as 
magnesium oxide, are best adapted. After the ingestion of 
fuming acids or the inhalation of fumes of nitric or hydrochloric, 
death may take place immediately from oedema or spasm of the 
glottis. If the subject survives long enough, he may later die of 
pneumonia. 

Besides the corrosive form of poisoning, another may be seen 
in herbivorous animals after internal administration of dilute 
acids. This is the so-called "acid-intoxication" which is due 
to the diminution of the alkalinity of the blood incident to the 
combination of the absorbed acid with its fixed alkali and the 
excretion of the resulting compound. Thus, as the alkalinity of 
the blood becomes lowered, less and less carbon dioxide is ab- 
sorbed from the tissues, and in consequence of this diminution 
of internal respiration the animal dies from asphyxia before the 
blood becomes acid or even neutral. The symptoms consist, at 
first, of deep gasping respirations (air hunger), which afterwards 
become shallow and superficial until they stop entirely. The 
heart grows progressively weaker and consciousness is gradually 
lost. 

After internal administration of acids this intoxication is not 
seen in men or dogs. The probable explanation is that these 
animals, being carnivorous, have a protective metabolism against 
acid-intoxication. Since their food, meat, gives rise to the for- 
mation of much acid, and since they do not take, as herbivor- 
ous animals, large quantities of alkaline salts in their diet, their 
bodies easily form the alkali ammonia which neutralizes the acids 
ingested or produced by their metabolism. These are excreted, 
in carnivora, mainly as ammonium compounds. The increase 



GROUP OF ACIDS. 205 

in the ammonia excretion after the administration of acids is at 
the expense of the urea which is correspondingly diminished. 

Acid-intoxication may also be produced in carnivorous animals 
by intravenous or subcutaneous injections of acids, thus intro- 
ducing larger quantities than they can neutralize. A typical acid- 
intoxication is seen in man at the end of the disease diabetes. 
In this condition oxybutyric and diacetic acids are formed so 
rapidly that the protective mechanism is insufficient to neutralize 
them, although enormous quantities of ammonia are found in 
the blood and urine. Sometimes as much as 140 grammes of 
acids have been recovered from the body in twenty-four hours, 
just before death in diabetic coma; it is not surprising under 
such circumstances that ammonia cannot be manufactured 
rapidly enough. 

The excretion of acids takes place by the kidneys in herbivora 
in the form of salts of potassium, in carnivora chiefly of salts of 
ammonia; but the body tries to retain all the alkalies possible 
and throws them out in the form of acid salts and occasionally 
as free acids. These may markedly irritate the kidneys so that 
albumen, casts and blood may be present in the urine. They 
may cause pain over the bladder and a burning feeling during 
urination due to irritation of the bladder and urethr,a. 

The ORGANIC ACIDS, as acetic, citric, lactic and tartaric, are 
absorbed as salts of the alkalies and during their passage through 
the body are in most part oxidized to carbonates and excreted 
as such by the kidneys, so that after internal administration they 
do not decrease the alkalinity of the blood nor do they make 
the urine more acid. 

As mentioned before, many of the organic acids are also very 
irritating in concentrated form, but when diluted they exert only 
gentle stimulant action, which when taken internally may help 
to remedy dryness of the mouth and to quench thirst by stimu- 
lating the mucous secretions and saliva. Externally, in the form 
of vinegar rubs, they may stimulate the skin, cause sweating, 
and reflex stimulation of the central nervous system and 
circulation. 



206 INORGANIC DRUGS. 

CARBONIC ACID is one of the weakest, possessing only mild 
irritant properties. Yet when inhaled in concentrated form, it is 
capable of producing a reflex spasm of the glottis. 

When applied to mucous membranes or denuded surfaces, 
it produces at first a sensation of burning, then one of numbness 
or local anaesthesia. 

Taken internally, it probably increases reflexly the flow of the 
digestive juices. It augments markedly the absorption of water 
from the intestines and consequently the excretion through the 
kidney. It also aids the absorption of alcohol by the stomach. 

When breathed, carbonic acid first stimulates the central 
nervous system, producing deeper breathing. This is fol- 
lowed by depression with hypnosis and death from paralysis 
of respiration. Its constitutional action is not seen after inges- 
tion, because very little is absorbed and it is quickly excreted 
by the lungs. 

SUMMARY OF GROUP ACTION.— A ction due to acid consti- 
tution. Caustics and irritants, in concentrated form. Stimulants 
and antiseptics, in diluted form. Poisoning by internal administra- 
tion of strong concentrated acids, gastro-enteritis. In herbivora by 
ingestion and in carnivora by intravenous injection, acid intoxi- 
cation with decrease in alkalinity of the blood, diminution of the 
power of taking up carbon dioxide from the tissues and death from 
asphyxia. 

THERAPEUTIC APPLICATION.— The stronger acids, es- 
pecially nitric, glacial acetic and trichloracetic, are used as 
caustics to burn off epitheliomata, chancres and gangrenous ulcers. 
They were also formerly frequently employed as hemostatics. 

Dilute acids, as acetic, are used externally and by inhalation to 
reflexly stimulate the central nervous system. 

Citric acid is given in the form of lemonade in fevers to re- 
flexly stimulate salivary secretion, and thus relieve dryness of the 
mouth. 

Dilute mineral acids, especially hydrochloric, are used to 
replace deficiency in the normal acidity of the stomach and thus 
to help the pepsin to carry on digestion. Mineral acids should 



GROUP OF ACIDS. 207 

always be given through a glass tube to prevent destruction of 
the teeth. 

Acids, especially dilute organic, as vinegar, are useful antidotes 
in cases of alkali poisoning. 

Hydrochloric acid, which acts as the normal antiseptic of the 
stomach, is sometimes used to prevent certain forms of fermenta- 
tion in the latter. 

Boric acid, although very weak, is often employed as an anti- 
septic wash in the nose, throat, mouth, vagina, rectum, ear, etc. 

Carbonic acid has been used in the form of baths as a reflex 
stimulant to the central nervous system, circulation and metab- 
olism. Taken internally, it also increases the nutrition through 
the larger absorption of water which it produces. 

On account of its local anaesthetic action, it was formerly 
used to wash wounds. It is now given in the form of sparkling 
drinks as soda water or champagne to check pain in the stomach 
and nausea or vomiting in seasickness and pregnancy. 

MATERIA MEDICA. 

Acidum Sulphuricum (U.S. P., B.P.), a colorless, oily liquid containing 
not less than 92^ per cent, by weight of sulphuric acid. 

Acidum Sulphuricum Dilutum (U.S. P., B. P.) contains 10 percent, by 
weight of sulphuric acid. Dose: — 0.5 to 2.0 c.c. Br. (10-30 irjj). Average 

(U.S.P.),2.0C.C. 

Acidum Sulphuricum Aromaticum (U.S.P., B.P.) contains 20 per 
cent, by weight of sulphuric acid besides oil of cinnamon, tincture of ginger 
and alcohol. Dose: — 0.3 to 1.0 c.c. Br. (8-15157). Average (U.S. P.), 
1.0 c.c. 

Acidum Nitricum (U.S. P., B.P.), colorless, fuming liquid containing 68 
per cent, by weight of nitric acid. 

Acidum Nitricum Dilutum (U.S.P., B.P.)' contains 10 per cent, by 
weight of nitric acid. Dose: — 0.5 to 2.0 c.c. Br. (10-20 ng). Average 

(U.S.P.),2.0CC. 

Acidum Nitrohydrochloricum (U.S. P.) contains 18 parts of nitric 
acid and 82 parts of hydrochloric acid. 

Acidum Nitrohydrochloricum Dilutum (U.S.P.) contains 4 parts of 
nitric acid, 18 of hydrochloric, and 78 of water. Dose: — 0.5 to 2.0 c.c. 
Average (U.S.P.) , 2.0 c.c. 

Acidum Hydrochloricum (U.S.P., B.P.), colorless, fuming liquid con- 
taining 31.9 per cent, of hydrochloric acid. 

Acidum Hydrochloricum Dilutum (U.S.P., B.P.) contains about 10 
per cent, hydrochloric acid. Dose: — 0.5 to 2.0 c.c. Br. (10-30 n#). Aver- 
age (U.S.P.), 1.0 c.c. 



208 INORGANIC DRUGS. 

Acidum Phosphoricum (U.S.P., B.P.), colorless liquid containing 85 
per cent, by weight of absolute orthophosphoric acid. 

Acidum Phosphoricum Dilutum (U.S.P., B.P.) contains 10 per cent, 
of orthophosphoric acid. Dose: — 0.5 to 2.0 c.c. Br. (10-30 ng). Average 
(U.S.P.),2.o c.c. 

Acidum Aceticum Glaciale (U.S.P., B.P.) contains at least 99 per 
cent, absolute acetic acid. 

Acidum Aceticum (U.S.P., B.P.), colorless liquid, having the smell and 
taste of vinegar, contains 36 per cent, by weight of absolute acetic acid. 

Acidum Aceticum Dilutum (U.S.P., B.P.) contains 6 per cent, acetic 
acid. Dose: — 5.0 to 15.0 c.c. Br. (1-4 fl. 3). Average (U.S.P.), 2.0 c.c. 

Acidum Trichloraceticum, colorless, deliquescent crystals, soluble in 
alcohol and ether, decomposed by heat in the presence of sodium carbonate 
into chloroform. 

Acidum Citricum (U.S.P., B.P.), colorless crystals, very soluble in 
water. Dose: — 0.5 to 2.0 c.c. Br. (3-30 grains). Average (U.S.P.), 
0.5 G. 

Syrupus Acidi Citrici (U.S.P.) contains 1 per cent, citric acid. Dose: 
— 5.0 to 15.0 c.c. 

Acidum Tartaricum (U.S.P., B.P.), colorless crystals, easily soluble in 
water, soluble in 2^ parts of alcohol. Dose: — 0.5 to 2.0 G. Br. (5-20 
grains). Average (U.S.P.) , 0.5 G. 

Acidum Lacticum (U.S.P., B.P.), colorless, syrupy liquid, containing 
75 per cent, by weight of absolute lactic acid. Dose : — 0.5 to 2.0 c.c. 

Acidum Boricum (U.S.P., B.P.), colorless crystals with a slightly bitter 
acid taste, soluble in 25 parts of water, in 10 of glycerine and 15 of alcohol. 
Dose : — 0.5 to 2.0 G. Br. (5-15 grains). Average (U.S.P.), 0.5 G. 

Glyceritum Boroglycerini (U.S.P.), Glyceritum Acidi Borici (B.P.), 
contains 31 per cent, of boric acid. 



GROUP OF ALKALIES. 

Just as the members of the previous group contain substances 
which act only through their acid properties, so those of this 
division have little or no other action, except that imparted to 
them through their basic nature. Such basic bodies as the 
alkaloids with a marked special effect are excluded. 

The stronger members, SODIUM and POTASSIUM HY- 
DRATE and CALCIUM OXIDE in concentrated form act as power- 
ful caustics. This effect is due partly to the withdrawing of water, 
as in the case of the acids, and partly by the transformation of the 
proteids into soluble alkali albuminates, by the solution of con- 
nective tissue and saponification of the fats. Since the products 
of this caustic action are soluble, there is a great tendency for 
diffusion and deep-seated destruction, so that here lies an essen- 



GROUP OF ALKALIES. 2O0, 

tial difference between caustic action by alkalies and by acids, the 
latter having the tendency only to produce localized destruction, 
because they coagulate the proteids. With alkalies, as with most 
other chemical caustics, everything is destroyed with which they 
come in contact, including skin, muscle, vessels, nerves and new 
growths. The corrosive effect here is also attended by inflam- 
matory reaction at the boundary between the destroyed and 
living tissues. 

Taken internally in concentrated form, the symptoms are 
those of gastro-enteritis with a greater tendency to perforation 
than with strong acids. There is great pain in the mouth, throat, 
oesophagus and stomach with vomiting and frequently diarrhoea, 
also early symptoms of collapse especially if perforation has oc- 
curred. The burned mucous membrane is soft, slimy and 
mushy after caustic alkali poisoning, while it is tough and puck- 
ered after burning with acids. 

In dilute solution, the caustic alkalies act only as local irritants, 
the amount of irritation varying with the concentration. Even 
in dilute solutions, albumins are transformed to alkali albu- 
minates. The skin after topical application is first entirely 
cleansed of the oil and dirt, then the superficial layers of the 
epidermis are dissolved, when it becomes reddened and irritated. 
In the mouth, there is the typical "lye taste" and a solution of 
the superficial layers of the mucosa, while the latter is bright red 
and feels slippery. Dilute alkalies in the stomach neutralize 
the normal hydrochloric acid and interfere with the digestion of 
proteids if the secretion is normal, but may aid the symptoms of 
hyperacidity if the latter is present. They were formerly thought 
to exercise a stimulant action on gastric secretion, but experi- 
ments seem to show that they decrease hyperacidity when given 
over a prolonged period of time. In the intestines they may 
neutralize an excess of acid coming from the stomach. They 
dissolve the mucus in catarrhal conditions, but have no in- 
fluence on the secretion of bile. 

The weaker members of the group, such as the CARBONATES, 
BICARBONATES and PHOSPHATES, do not act as caustics, 
14 



2IO INORGANIC DRUGS. 

but only as irritants. They may dissolve the superficial layers of- 
the epidermis, but do not produce deep destruction. 

MAGNESIUM OXIDE is practically insoluble in water and 
possesses no irritant properties. When administered internally, 
it neutralizes the hydrochloric acid in the gastric juice and on 
reaching the intestine, by virtue of the specific action of the mag- 
nesium ions on the intestinal mucosa, it sets up the reflex which 
causes increased peristalsis and a laxative effect. 

The hydrates are probably absorbed as carbonates or as alkali 
albuminates. They become saturated with carbon dioxide in 
the blood and are excreted in this combination by the kidneys 
and possibly by the respiratory mucous membranes. 

All alkalies are readily excreted, so that the increase in alka- 
linity of the blood is never very great, although when abnormally 
large quantities of acids are formed in the system, as in diabetes, 
they may protect the organism from acid-intoxication. On ac- 
count of their excretion by the kidneys, they make the urine al- 
kaline or less acid, and increase the total secretion. By their 
probable excretion on the bronchial mucous membrane, they 
are said to act as expectorants and in pathological conditions to 
render the mucus less tenacious and more easily expelled. 

There is a small increase in metabolism which, if not due to the 
augmented alkalinity of the blood, can be explained by salt 
action and the greater interchange of fluids in the tissues. The 
total nitrogen in the urine is not much affected, but its form is 
changed, as the ammonia is decreased with a corresponding in- 
crease in the urea. The uric acid excretion varies, sometimes 
being augmented and at other times diminished. French authors 
believe that alkalies produce a retention of water in the body due 
to the retention of chlorides which follows their use and that actual 
oedema may follow the use of too great quantities of sodium bi- 
carbonate. An opposite view is held by some workers in this 
country, who believe, on the contrary, that acidity of tissues due 
to stasis causes oedema, while alkalinity prevents this result. 

The bicarbonates and phosphates of the alkalies, as also mag- 



GROUP OF ALKALIES. 211 

nesium oxide, are not quickly absorbed, so they possess in addi- 
tion a laxative effect due to their local action on the intestines. 

SUMMARY OF GROUP ACTION.— Action through the basic 
ions on account of their power of neutralizing acids and dissolving 
proteids. Caustics in great concentration. Irritants, stimulants 
and solvents for mucus in diluted solutions. Absorbed as alkaline 
carbonates and albuminates. Excreted as carbonates by the urine. 
Temporary increase in the alkalinity of the blood. Poisoning from 
concentrated solutions consists of acute gastro-enteritis. 

THERAPEUTIC APPLICATION.— The caustic alkalies are 
used in medicine to burn off new growths and other undesirable 
products of disease. After such application the surrounding 
tissues should be washed with dilute acids to prevent too great 
spreading. 

In the form of bicarbonate or phosphate of sodium, alkalies 
are useful to dissolve the mucus in catarrh of the stomach. They 
are of value in neutralizing an excessive secretion of hydrochloric 
acid. They are also employed in cases of acid poisoning. For 
this purpose hydrates or oxides are preferable to carbonates 
because no gas is liberated which might distend the stomach. 
The alkali oxides or hydrates may also be used in dilute forms to 
take up an excess of carbon dioxide gas in the stomach or in- 
testines. 

The alkalies are used especially in the form of mineral waters 
in the treatment of diseases with faulty metabolism, as gout, rheu- 
matism and diabetes. But in the latter they are strongly in- 
dicated at the approach of coma due to acid-intoxication when 
sodium bicarbonate is given not only internally but also sub- 
cutaneously or intravenously. By the latter method, solutions 
of from ^ to 10 per cent, have been used by the different 
authors. It often seems as if they retard the fatal result. In 
Brighfs disease alkalies act beneficially by aiding in the removal 
of the oedema through their diuretic effect and possibly also by 
aiding in the solution or dislodgment of fibrinous exudates in the 
renal tubules. 

They are indicated as expectorants in bronchitis or in other 



212 INORGANIC DRUGS. 

conditions of the respiratory tract where tenacious mucus must 
be removed. They are used locally to cleanse various mucous 
membranes, as those of the nose and throat in catarrhal processes. 
On the skin in the form of baths they soften its superficial layers 
and stimulate its nutrition so that certain skin diseases are at 
times benefited by alkaline baths. 

Magnesium Oxide is the most valuable agent for neutralizing 
the excess of hydrochloric acid in the stomach in cases of ulcer, 
erosions, pyloro-spasm and acid gastritis. It is also very valu- 
able as a laxative in the dose of ^ to 2 teaspoonfuls mixed in 
y£ glass water before retiring at night. 

MATERIA MEDICA. 

Potassii Hydroxidum (U.S.P.), Potassa Caustica (B.P.), dry, white, 
translucent pencils or fused masses, odorless, or having a faint odor of lye 
and a very acrid and caustic taste. Exposed to the air, it rapidly absorbs 
carbon dioxide and moisture and deliquesces. 

Liquor Potassii Hydroxidi (U.S. P.), Liquor Potassse (B.P.), contains 5 
per cent, potassium hydrate. Dose : — 0.5 to 2.0 c.c. Br. (5-20 ttjj). Aver- . 
age (U.S.P.), 1.0 c.c. 

Potassa Cum Calce (U.S. P.), grayish- white deliquescent powder, con- 
taining equal parts of potassium hydrate and calcium oxide. 

Potassii Carbonas (U.S. P., B.P.), white, granular, odorless powder with 
a strong alkaline reaction and taste, deliquescent, very soluble in water, 
but insoluble in alcohol. Dose: — 0.5 to 2.0 G. Br. (5-20 grains). Aver- 
age (U.S.P.), 1.0 G. 

Potassii Bicarbonas (U.S. P., B.P.), colorless, odorless crystals with a 
slightly alkaline and saline taste and permanent in air. Soluble in 3.2 
parts of water, almost insoluble in alcohol. Dose: — 0.5 to 4.0 G. Br. 
(5-40 grains). Average (U.S. P.), 2.0 G. 

Potassii Acetas (U.S.P., B.P.), white powder or crystalline mass, odor- 
less, but having a saline taste. Very deliquescent. Very soluble in water, 
soluble in 1.9 parts of alcohol. Dose: — 0.5 to 4.0 G. Br. (5-40 grains). 
Average (U.S.P.), 2.0 G. 

Potassii Citras (U.S. P., B.P.), deliquescent, white crystals having a 
cooling saline taste. Very soluble in water, slightly soluble in alcohol. 
Dose : — 0.5 to 4.0 G. Br. (5-40 grains). Average (U.S.P.), 1.0 G. 

Potassii Citras Effervescens (U.S. P.), white, odorless powder contain- 
ing 63 parts of citric acid, 90 of potassium bicarbonate, 47 of sugar. Dose : 
—0.5 to 4.0 G. Average (U.S.P.), 4.0 G. 

Potassii Oleas, or soft soap. 

Sodii Hydroxidi (U.S.P.), Soda (B.P.), dry, white, translucent pencils or 
fused masses, odorless, having an acrid caustic taste. 

Liquor Sodii Hydroxidi (U.S.P.), Liquor Sodae (B.P.), contains 5 per 
cent, sodium hydrate. Dose: — 0.5 to 2.0 c.c. Br. (5-20 itjj). Average 
(U.S.P.), 1.0 c.c. 



GROUP OF ALKALIES. 213 

Sodii Carbonas (U.S.P., B.P.), colorless, odorless crystals, having a 
strong alkaline taste and reaction. Effloresces in the air. Very soluble in 
water, insoluble in alcohol and ether. Dose: — 0.3 to 1.0 G. Br. (5-15 
grains). Average (U.S.P.), 0.25 G. 

Sodii Bicarbonas (U.S.P., B.P.), white powder with a cooling, alkaline 
taste. Soluble in n. 3 parts of water, insoluble in alcohol and ether. Dose : 
— 0.5 to 4.0 G. Br. (5-60 grains). Average (U.S.P.), 1.0 G. 

Trochisci Sodii Bicarbonatis (U.S.P., B.P.) contains 0.2 G. sodium 
bicarbonate. Dose : — 1 to 6 troches. 

Sodii Boras (U.S. P.) or Borax, white crystalline powder, soluble in water. 
Dose :— Average (U.S.P.), 0.5 G. 

Sodii Acetas (U.S.P., B.P.), colorless, odorless, efflorescent crystals, 
having a cooling, saline taste, very soluble in water, soluble in 30 parts of 
alcohol. Dose: — 0.5 to 4.0 G. Br. (5-60 grains). Average (U.S. P.), 
1.0G. 

Sodii Oleas, or hard soap. 

Calx (U.S. P., B.P.), hard, grayish- white masses which attract water and 
carbon dioxide and fall into a white odorless powder (slaked lime) . 

Liquor Calcis (U.S.P., B.P.) contains .17 per cent, of calcium hydrate. 
Dose: — 5.0 to 30.0 c.c. Br. (1-4 S). 

Calcii Carbonas Praecipitatus (U.S. P., B.P.), white, odorless, tasteless 
powder practically insoluble in water and alcohol. Dose: — 0.5 to 4.0 G. 
Br. (5-60 grains). Average (U.S.P.), 1.0 G. 

Creta Praeparata (U.S.P., B.P.), a white, amorphous powder, odorless 
and tasteless, almost insoluble in water and alcohol. Dose : — 0.5 to 4.0 G. 
Br. (5-60 grains). Average (U.S. P.), 1.0. 

Pulvis Cretae Compositus (U.S.P., B.P.) (compound chalk powder) 
contains 30 parts of chalk, 20 of acacia and 50 of sugar. Dose: — 0.5 to 
4.0 G. Br. (5-60 grains). Average (U.S.P.), 2.0. 

Mistura Cretae (U.S. P.) contains chalk powder and cinnamon water. 
Dose: — 5.0 to 20.0 c.c. Average (U.S.P.), 16.0 c.c. 

Trochisci Cretae (U.S.P.) contains .25 G. of chalk per troche. 

Calcii Phosphas Praecipitatus (U.S.P.), Calcii Phosphas (B.P.), amor- 
phous, odorless, tasteless powder, permanent in air. Dose: — 0.5 to 4.0 G. 
Br. (5-60 grains). Average (U.S.P.) , 2.0. 

Syrupus Calcii Lactophosphatis (U.S.P., B.P.). Dose: — 5.0 to 10.0 
c.c. Average (U.S.P.), 8.0 c.c. 

Magnesii Oxidum Ponderosum (U.S.P.), Magnesia Ponderosa (B.P.), 
white powder without odor, but with an earthy taste, almost insoluble in 
water and alcohol. Dose: — 0.5 to 4.0 G. Br. (5-60 grains). Average 
(U.S.P.), 2.0 G. 

Magnesii Carbonas (U.S.P.), white powder, almost insoluble in water 
and alcohol. Dose: — 0.5 to 4.0 G. Br. (5-60 grains). Average (U.S.P.), 
3.0 G. 

Lithii Carbonas (U.S.P., B.P.) , a white, alkaline powder, soluble in 80 
parts of water, insoluble in alcohol. Dose: — 0.2 to 0.5 G. Br. (3-10 
grains). Average (U.S.P.), 0.5 G. 

Lithii Citras (U.S.P.), a white powder, soluble in 2 parts of water, in- 
soluble in alcohol. Dose : — 0.2 to 1.0 G. Average (U.S.P.), 0.5 G. 

Lithii Citras Efifervescens (U.S.P.) contains about 7 per cent, lithium 
citrate. Dose :— 0.5 to 4.0 G. Average (U.S.P.), 8.0 G. 



214 INORGANIC DRUGS. 

GROUP OF NEUTRAL SALTS. 

The pharmacological action of neutral salts is dependent both 
upon their chemical and physical properties. The action, which 
depends upon the physical properties of salts being so charac- 
teristic of the latter, is surnamed salt action. 

Some neutral salts pass easily through most animal membranes, 
others diffuse with difficulty. The former are rapidly absorbed 
by the intestinal mucous membrane, while the latter remain al- 
most unabsorbed. 

"SALT ACTION." 

Salt action is thus called, because it is a physical action, char- 
acteristic of salts, yet it may be seen with cane-sugar. 

This action may be briefly described as the change in propor- 
tion between certain solid elements as salts, and liquids as water, 
in some inert colloid, as in gelatine plates or in living tissues. 
This process depends upon diffusion and the tendency of two 
fluids containing varying proportions of salts to become of equal 
density. Thus, the water passes over to the more concentrated 
solution, while the salt flows in the opposite direction to the more 
dilute solution. 

When no specific irritant qualities are possessed by salts, this 
salt action may alone be able to irritate body tissues, the in- 
tensity of the irritation varying, to a certain extent, with the 
difference of concentration of the salt solution in relation to that 
of body fluids. Solutions of equal concentration to blood serum 
are said to be isotonic. Solutions of greater concentration are 
said to be hypertonic, while those of lesser concentration are said 
to be hypotonic. 

Both hypotonic and hypertonic solutions change the composi- 
tion of protoplasm and irritate the same. On blood corpuscles, 
hypotonic solutions cause a diffusion of the hemoglobin out of the 
cells. 

By varying its salt concentration, the entire living organism 
may be definitely affected in its metabolism. 



GROUP OF NEUTRAL SALTS. 215 

Although a few years ago, almost all action of neutral salts was 
ascribed to their physical properties — i.e., "salt action"; now- 
adays, new evidence has been brought forward to show special 
chemical action with nearly all salts, even with sodium chloride. 
The truth is that the action of neutral salts is dependent upon 
both salt action and specific ionic action. With some, the salt 
action is paramount, as with sodium chloride, while with others, 
as the bromides, the ionic action is most important. 



ACTION DUE TO IONIC CONSTITUTION. 

Although the physical "salt action" forms an important part 
of the action of some salts, yet a specific action, due to the ionic 
composition, exists in all. Sodium Chloride, which is such an 
important and copious constituent of all soft body tissues, has 
the least effect. In fact it is its absence or diminution which 
causes most important changes. Thus sodium and chlorin ions 
have very low toxic effects and it is only in very large doses that 
any such can be elicited. 

The animal organism is protected against the toxic action of 
sodium, potassium, calcium and magnesium when introduced by 
mouth, by the fact that the simple compounds of these are ab- 
sorbed more slowly than they are excreted. This process pre- 
vents the accumulation of a toxic amount after internal adminis- 
tration. The case is very different after intravenous adminis- 
tration, when the chloride salt of all these proves toxic, and as in- 
terestingly proved by Meltzer and Joseph the toxicity varies in- 
versely with the amount of these present in the animal serum. 
The smaller the amount of the ion in the serum, the more toxic 
it is in the infusion. Thus sodium is least toxic. Next comes 
potassium which is half as toxic as calcium ; while calcium is three 
times less toxic than magnesium. Below is a table extracted 
from the article by Meltzer and Joseph which is self-explanatory. 



2l6 



INORGANIC DRUGS. 
TABLE BY MELTZER AND JOSEPH 



Substances 



Existing in the 

Blood in Relative 

Concentration 



Magnesium 
Calcium . . 
Potassium . 
Sodium 




Fatal in Relative 
Doses 



I.oo 
2.80 
4.26 

25.54 



Other ions, as those of barium, iodin, and bromin, exert their 
specific effect even after internal administration. This is possible 
because the ratio between their absorption and excretion is such 
that an amount may accumulate in the blood sufficient to produce 
their specific pharmacological action. 



GENERAL ACTION OF SALTS OF DIFFICULT 
ABSORPTION. 

This class is chiefly represented by the sulphates and phos- 
phates. Taken internally, they may produce nausea and vomit- 
ing both on account of their disagreeable bitter taste and because 
of their local action on the stomach. 

As they are difficultly absorbed, but at the same time readily 
excreted, they are never present in the blood in sufficient quan- 
tities after internal administration to alter the metabolism. 
When applied to the skin they irritate it according to their 
concentration. They alter its nutrition and thus may influence 
different skin affections, although they are not absorbed except 
in the most superficial layers of the epidermis. Thus, by external 
application, they cannot pass into the blood, therefore do not 
influence the metabolism directly, although by their local irri- 
tant effect they may change the nutrition of the body in a reflex 
manner. 

If sodium sulphate is injected subcutaneously or intravenously, 
it then exerts a marked effect upon the body fluids and the nutri- 
tion, and increases enormously the secretion of urine just as the 
members of the sodium chloride class. 



GROUP OF NEUTRAL SALTS. 21 7 

GENERAL ACTION OF SALTS OF EASY ABSORP- 
TION. 

Whenever solutions of SODIUM CHLORIDE or other easily 
absorbable salts of this division as other chlorides, iodides, bro- 
mides, etc., come in contact with tissues containing less salts, 
they draw water from them. They tend to pass into the tissues 
or on the other side of the membranes and when their concentra- 
tion is equalized on both sides, their action ceases. They are 
more rapidly absorbed by the stomach in concentrated, but by 
the intestines in diluted solutions. 

Locally applied to the skin, they cause irritation. This irri- 
tant effect is followed by a slight local anaesthetic action, especially 
observed with bodies containing potassium or bromide ions. 
They also act as mild antiseptics in sufficient concentration. 
After internal administration, the irritant action is well marked 
on the mouth, oesophagus and stomach so that nausea and vomit- 
ing occur after large doses. These, long continued, may even 
produce catarrh of the stomach. 

Since they are rapidly absorbed from the upper part of the 
small intestines, they exert no direct influence on the lower 
portion nor upon the large bowel, and therefore cause but an 
insignificant cathartic action compared with the members of the 
sodium sulphate group. 

On the other hand, they produce a marked influence on metab- 
olism, and they increase markedly the secretion of the kidneys 
and also that of the bronchial mucous membrane which they 
make more fluid and less tenacious. 

These salts increase the metabolism by augmenting the inter- 
change of fluids in the body, thus exciting the tissues to greater 
activity. As soon as they are absorbed into the blood, the latter 
having greater osmotic pressure draws water from the lymph- 
atics and tissues; but the salts also pass into both these and are 
excreted by the kidneys so that the osmotic pressure of the blood 
diminishes again. Fluids pass from the blood to the lymph and 
tissues, but as more of the salts are absorbed from the intestines, 



2l8 INORGANIC DRUGS. 

the blood again acquires a greater osmotic pressure and the cur- 
rents change and thus the circle continues. 

Increased metabolism may result after the external application 
of salts in the form of baths. In this instance the effect is only 
reflex by the local irritation, for they are not absorbed by un- 
broken skin. 

The urine voided by an animal is the sum of the fluid and 
various solid constituents which have diffused through the glom- 
eruli, minus that portion which has been reabsorbed by the 
convoluted tubules. The salts act as diuretics, probably 
both by increasing the bulk of the blood and therefore the quan- 
tity circulating through the kidneys, and by decreasing the re- 
absorption of fluids by the convoluted tubules. Some, such as 
chlorates and nitrites, seem to exert a direct irritant action upon 
the kidney. 

The salts of this division act as expectorants by virtue of their 
local irritant action after excretion on the bronchial mucous 
membrane and by their power of softening mucus. This sol- 
vent action on mucus can also be observed in the stomach when 
it contains an excessive amount as in catarrh. 

These salts, as well as those of the sodium sulphate group, 
often cause an increased thirst on account of their affinity for 
water and because by their action they tend to decrease the water 
of the body. 

INTESTINAL ACTION OF SALTS. 

The easiest way to present the mode of action of the neutral 
salts on the intestines is to quote from the author's experimental 
conclusions. 

The neutral salts can be divided into four classes : first, those 
which do not exert a marked stimulant action on the mucous 
membrane of the intestines leading to increased peristalsis, as 
sodium chloride; second, those which exert a marked stimulant 
action on the mucous membrane of the intestines leading to in- 
creased peristalsis, as sodium phosphate and sodium sulphate; 
third, those which, although stimulating the mucous membrane 
and leading to peristalsis, depress the neuro -muscular elements 



GROUP OF NEUTRAL SALTS. 210, 

when applied to them, such as magnesium sulphate; fourth, those 
which exert a special stimulant action on the neuro-muscular ele- 
ments of the intestines, like physostigmine and ergot. These are 
best represented by barium chloride. It is difficult to draw a 
sharp line of distinction between class I and class II, because 
there are a number of salts which may produce a certain amount 
of peristalsis but not powerful enough to cause rapid onward 
movement of the intestinal contents, which would stand between 
the two classes. 

The three salts, magnesium sulphate, sodium sulphate and 
sodium phosphate, act very differently when applied to the 
mucous membrane or to the serous surface of the intes- 
tines, in fact, the action is opposite. It is known that these 
salts are absorbed with difficulty from the mucous membrane of 
the intestines, while infinitely more easily from the subcutaneous 
or serous channels. Therefore, it is fair to suppose that the action 
after the application to the serous surface of an extirpated in- 
testine separated from the central nervous system represents the 
effect after absorption upon the neuro-muscular elements of the 
intestines. On the contrary, the results obtained after applica- 
tion to the mucous membrane can, in view of these experiments, 
be considered rather as a local effect, something after the manner of 
the skin irritants. The question then arises whether this local 
irritant effect is dependent upon the power of the salts to draw 
water from the cells of the mucous membrane and thus to stimu- 
late or irritate these, or whether the stimulation depends upon 
the chemical constitution of the salt. The author believes that 
the second condition is paramount, because the amount of stimu- 
lation only depends to a certain point upon the concentration of 
the salt solution and furthermore, these, which are all three 
"purgative salts," show much more stimulant effect than sodium 
chloride (not a purgative salt) in hypertonic solutions. 

It would seem as if purgation by these salts was dependent 
on a specific irritation of the mucous membrane responded 
to by a reflex increased motor activity. Catharsis by drugs 
is certainly not wholly dependent upon general intensity of the 
irritation but rather upon the specificness of the stimulation. 



2 20 INORGANIC DRUGS. 

Magnesium in most of its common combinations is well known to 
depress the motor activity of the neuro-muscular elements of the 
intestines, yet the insoluble magnesium oxide in such doses as 
^ to i teaspoonful (personal observations on different human 
beings) where exclusive "salt action" is not probable, has un- 
doubted purgative action, although very little irritant effect. 
It probably forms a chloride in the stomach and salts of fatty acids 
in the intestines which however, are probably not great irritants, 
for no matter how large the dose (8-10 teaspoonfuls), no gastro- 
intestinal inflammation has been observed. (Author's observa- 
tion.) It thus seems plausible that some magnesium salts have a 
special stimulant action on the mucosa leading to a reflex result- 
ing in purgation. 

That the change in osmotic pressure brought about by those 
salts taken in large quantities may be partially concerned in the 
stimulation, cannot be denied, but from my experiments, I cer- 
tainly could not see the situation in the light of all the other 
authors with the osmotic pressure theory, that the drawing of 
fluids from the vessels into the intestines or the retaining of the 
fluids which are already in the lumen is the chief cause of cathar- 
sis ; because in my personal experiments increased effective move- 
ments were obtained before there had been time for the passage 
of much fluid from the outer into the inner portion of the gut. 
Furthermore, in series No. 1 by comparing the quantity of fluid 
which entered and left the intestine there was never a large sur- 
plus, not more than 2-3 c.c. in 30-40 ex., which had passed the 
intestine. The experiments of Merckx support the author's 
view that the hygroscopic action of salts is not essential in purga- 
tion. He examined the concentration of the intestinal contents 
at different levels after saline purgatives, and found that the con- 
centration in cathartic salts was greater at the lower than at the 
upper fistula. Thus he showed that in living animals purgative 
salts do not steadily increase the watery contents of the intestine 
in their passage downward. 

Concerning the influence of salts placed in the nutritive medium 
in contact with the serous surface of the intestines, the following 






GROUP OF NEUTRAL SALTS. 2 21 

may be said. As might naturally be expected, any substance 
changing to an appreciable degree, qualitatively or quantitatively, 
the normal nutritive fluid will ultimately deteriorate the very 
sensitive intestine. The difference of action is more marked with 
some substances than with others, as for instance, magnesium 
sulphate has a far more depressive effect in the nutritive medium 
than sodium sulphate or sodium phosphate. If sodium sulphate 
or sodium phosphate are injected into the blood of living animals 
they may exert little or no paralyzing effect upon the intestine 
because being so diluted in the circulation, it is difficult to inject 
enough to sufficiently change the composition of the nutritive 
medium, the blood. With magnesium sulphate, as has been 
shown by Meltzer and Auer and others, small amounts injected 
into the blood will paralyze the intestine because this salt prob- 
ably has specific attractions for the neuro-muscular mechanism of 
the intestine, as in the case of atropine. Only the purgative 
effect and not the paralyzing action of magnesium sulphate is 
usually observed when given by mouth to man and other animals 
because not enough enters the circulation to exert the paralyzing 
effect upon the neuro-muscular element of the intestine, while a 
sufficient quantity is in contact with the mucous membrane to- 
wards which it exerts a stimulant action, causing reflex increase of 
peristalsis (by reflex is meant local reflex in the intestinal wall) . 
Thus the discrepancy of opinions between the authors who ob- 
served the purgative action of magnesium sulphate and those 
who observed a paralyzing effect on the intestine is easily explained. 
An apparent exception to the fact that a change in the normal 
nutritive medium of the isolated intestine injures the latter and 
depresses it, is the fact that barium chloride, ergot and physostig- 
mine, etc., increase the force of contraction when applied in this 
way. With these drugs the strong specific stimulation to the 
neuro-muscular element of the intestine masks the effects inci- 
dent to the change in the medium, and besides their action occurs 
in such minute doses that a very little quantitative change from 
the normal occurs in the medium. 



222 INORGANIC DRUGS. 

Concerning the old disputed question as to whether or not salts 
may act as a purgative when injected intravenously or sub- 
cutaneously, as would appear in the author's plan, depends enor- 
mously on the individuality of the salt. Thus those of the fourth 
class, as barium chloride, produces marked catharsis by intra- 
venous or subcutaneous injections (catharsis by subcutaneous or 
intravenous injections of barium chloride in rabbits and other 
animals is admitted by every one who has ever tried it). The 
third class, typically represented by magnesium sulphate, would 
produce the contrary effect and paralyze the intestine by intra- 
venous injections (discrepancy of opinion in this case probably 
depends on faulty technique or experimental inaccuracies). 
Those of the first and second class which have little or no action 
on the neuro-muscular elements would produce little or no effect 
by subcutaneous or intravenous injections. 

From all these observations, the author believes that peristalsis 
is the most important feature in purgation, because no matter how 
much water is present in the intestine if the neuromuscular ele- 
ment of the latter is depressed, onward movement does not well 
occur. Yet, one should distinguish between superficial peristalsis 
accomplishing but little, and deep effective peristaltic activity, 
pushing and squeezing forward the contents, and it is probably in 
this sense that the author differs from Auer, for when this latter 
experimenter obtained increased peristalsis from the subcutane- 
ous administration of some salts but no purgation, he concluded 
that peristalsis alone does not necessarily cause purgation. 

SPECIAL ACTION DUE TO IONIC CONSTITUTION. 

Sodium chloride or "common salt" is a necessary component 
of the organism. If an animal is fed on food which contains no 
sodium chloride he dies in a short time. Meats contain sodium 
chloride, but vegetable food contains very little, so that herbivora 
always seek for salt. Vegetable food not only does not furnish 
sufficient sodium chloride to the organism, but takes it away 
from the reserved supply in the following manner. The potas- 
sium phosphate present in large quantities in vegetable food re- 



GROUP OF NEUTRAL SALTS. . 223 

acts in the blood with the sodium chloride to form potassium 
chloride and sodium phosphate. These two salts are both rapidly 
excreted and thus the sodium chloride is lost. The loss could not 
take place without this reaction because the body retains sodium 
chloride tenaciously when only normal quantities are present. 

Sodium chloride is one of the salts most important to life, 
yet the others normally present in the body have also essential 
functions. When the former is injected intravenously it produces 
poisonous symptoms only when immense doses are used, so we 
deduce that both the sodium and the chlorine ions have very 
little tonic action. However, it is not so with the dissociated 
ions of potassium, calcium, bromine and iodine, etc., present in 
other neutral salts. 

POTASSIUM SALTS may produce death in doses of 7 to 8 mg. 
per kilo body weight when injected into the blood circulation. 
They depress the central nervous and muscular systems and heart, 
causing a slowing of the pulse and a sinking of the blood pressure. 
They produce death by cardiac paralysis. 

These symptoms can all be elicited both by intravenous and 
subcutaneous administration, but not when taken by the mouth, 
because then their excretion keeps pace with their absorption 
and never enough is present in the blood at one time. Locally 
they paralyze peripheral nerves. They are more irritant locally 
than sodium salts and also have a greater diuretic action. 

CALCIUM forms many insoluble and difficultly diffusible salts, 
but even the soluble ones are absorbed with great difficulty. 
After absorption it is excreted in the urine of herbivora, but in 
man mainly in the large intestines. 

Although a normal constituent of the highly organized body, 
calcium produces poisonous symptoms when injected into the 
blood in sufficient quantities. At first, it stimulates and strengthens 
the heart, but later depresses it. It also depresses the central 
nervous system. 

The lack of sufficient calcium in food, or lime starvation, is 
capable of producing marked changes, especially in the growing 
organism. As it is one of the main constituents of bone, an in- 



2 24 INORGANIC DRUGS. 

sufficient amount in food leads to softening of bones and condi- 
tions akin to rickets and osteomalacia. 

MAGNESIUM salts have only of late attracted interest con- 
cerning their internal action, although their purgative one has 
been studied and used practically for many years. 

As a rule, they do not produce constitutional action after in- 
ternal administration in man and many warm-blooded animals. 
Cannon discovered years ago that magnesium sulphate caused 
constitutional poisoning in cats after oral administration. 
Others have lately reported cases of poisoning in human beings 
after a purgative dose of magnesium sulphate. The discovery 
of this untoward action was rather startling, as epsom salt had 
been considered for scores of years as a harmless purgative. 
Such poisoning effects in man are, however, very rare because 
magnesium is as a rule excreted much faster than it is absorbed. 

Given intravenously or subcutaneously, magnesium salts are 
very toxic, much more so even than those of calcium and potas- 
sium. 

Their action consists of a paralysis of the motor end plates 
(curare-like), of the muscles of the central nervous system and 
heart. Death results from respiratory failure which is due to the 
combined paralysis of the respiratory center and of the respiratory 
muscles. Meltzer and Joseph were able to show a very interest- 
ing antagonistic action of physostigmine toward magnesia. 

When applied to nerve trunks, injected into the spinal canal or 
over the cerebrum, magnesium salts exert a local anesthetic 
action just like cocain. 

LITHIUM, STRONTIUM, RUBIDIUM and CESIUM salts 
have an action similar to that of potassium salts. 

BARIUM salts produce convulsions in frogs similar to those 
caused by picrotoxin. In these animals, they stimulate and then 
depress the heart just as the members of the digitalis group. 

In the warm-blooded, the symptoms after intravenous or 
subcutaneous injection consist of vomiting, diarrhoea, some- 
times light convulsions and death due to paralysis of the heart. 
There is at the beginning of the poisoning a characteristic rise 



GROUP OF NEUTRAL SALTS. 225 

of blood pressure which is due both to stimulation of the vasomotor 
centre and to direct action upon the vessel walls. 

Cases of poisoning in man exhibit chiefly great general weak- 
ness and motor paralysis of the limbs and of the sphincters of 
the bladder and anus. Deglutition is also impaired. The fatal 
dose of barium salts for rabbits, cats and dogs is 0.1-0.3 G. per 
kilo by subcutaneous injection. 

AMMONIUM compounds produce an intense stimulation of the 
central nervous system when injected subcutaneously or into the 
blood. This was described in detail in a previous chapter. 

The SULPHATE ions in neutral salts have in common with 
the chlorine ions, weak action. 

SULPHITES, through their dissociated ions, produce chiefly 
a paralysis of the central nervous system and heart after subcutane- 
ous or intravenous injection. The fatal dose for rabbits is 0.6 G. 
per kilo by subcutaneous injection. 

The ORTHO-PHOSPHATE ions produce little action, even 
after subcutaneous injection; but on the other hand, the pyro- 
and meta-phosphate produce fatty degeneration analogous to phos- 
phorus, but only after subcutaneous or intravenous administra- 
tion. 

CHLORATES are easily absorbed from the intestinal tract, 
even in quantities sufficient to produce poisonous symptoms. 
Besides their local irritant action, which is great, they possess 
a special action on red blood corpuscles. They break up 
the latter and transform the haemoglobin to methaemoglobin. 
They produce cyanosis, dyspnoea, feeble heart, headache, mus- 
cular weakness and death due to asphyxia. After internal ad- 
ministration they cause severe gastro-intestinal irritation. 

Given in smaller doses over a period of time they produce 
inflammation of the kidneys which results in uremia and death. 
This is due both to the local irritant action of the chlorates and 
of the free haemoglobin and methaemoglobin during their excre- 
tion by these organs. 

They are excreted' almost in to to by the urine; yet some 
believe that a small quantity passes into the saliva. 
15 



226 INORGANIC DRUGS. 

NITRATES have a severe irritant action; in fact, greater than 
can be accounted for by their salt action. 

In large quantities, they are destroyed in the body, probably 
reduced to ammonia. They produce a marked stimulation of 
the kidney which at first leads to an increased secretion, but 
later to inflammation and anuresis. 

FLUORIDES at first stimulate then depress the medulla, so 
that they cause increased respiration and circulation and also 
convulsions, succeeded by general paralysis and death due to 
stoppage of respiration, while the heart and skeletal muscles 
remain unaffected throughout the poisoning. The fatal dose 
given subcutaneously to animals is 0.10-0.15 G. per kilo body 
weight. 

BORATES and boric acid (the latter is so weak an acid that 
its action is the same as that of its salts), produce great hyperemia 
of the intestinal mucosa even after subcutaneous injection. The 
Peyer's patches are much swollen and there may be an exudation 
of bloody fluid in the gastro-intestinal tract after internal admin- 
istration. 

The symptoms consist of nausea, vomiting, diarrhoea, and 
collapse which is possibly due to the dilatation of the vessels 
of the splanchnic area just as with arsenic. 

After long use of boric acid preparation the kidneys may 
become irritated and secrete albuminous urine and the skin fre- 
quently exhibits eruptions. With large doses given over a period 
of time, they seriously disturb the pro teid metabolism, decreas- 
ing the absorption and increasing the combustion. They are very 
rapidly absorbed and excreted by the urine within thirty-six 
hours after ingestion. 

BROMIDES possess a very characteristic action not approached 
by that of any of the other halogen ions. 

The most striking effect is upon the central nervous system, 
especially on those parts of the cord connected with reflex action 
and those parts of the brain concerned with sensation and in- 
tellect. When given to the average human being in moderate 
medicinal doses (1 gramme or 15 grains three times daily), they 



GROUP OF NEUTRAL SALTS. 227 

produce few symptoms, except a sensation of relaxation and well- 
being. If there have been sleeplessness and nervousness, these 
states are corrected and besides a long night's sleep, a tendency 
to somnolence may occur during the day. 

When a large dose is given for a period of time, much more 
intense symptoms from the central nervous system may arise. 
These consist, sometimes of extreme somnolence; sometimes of 
dulling of the intellect, with defect of memory, difficulty of ex- 
pression and rarely of depression of spirits and melancholia. 
The gait is rarely affected, although with enormous doses it may 
become somewhat unsteady. 

Like other salts of this group, bromides have a well-marked, 
local irritant action, which may be seen at the place of adminis- 
tration, and also at the place of excretion. 

The stomach is particularly prone to irritation by the bromides 
when these are administered without sufficient food or alkalies, 
because, besides the irritant action of the salts themselves, the 
even more irritant hydrobromic acid is formed in the presence 
of free hydrochloric acid. Many physicians exclude bromides 
from their materia medica because of the nausea, occasional vomit- 
ing and other dyspeptic symptoms occurring after the improper 
use of these salts. This irritation can be easily overcome by ad- 
ministering bromide, always in the presence of an excess of al- 
kalies, and immediately after a full meal, which contained no acids. 
Under these circumstances, the author has never seen a case of 
gastric irritation, even in dyspeptics. 

Bromides are excreted by nearly all the excretory organs of the 
body, but chiefly by the urine. No inflammatory symptoms 
have ever been found in the kidneys after these drugs, yet, not 
infrequently, the diuresis is greatly increased, and occasionally, 
a burning sensation may be felt in the urethra. 

A certain amount of bromides are excreted by the skin and 
probably in consequence, a considerable percentage of people 
with irritable skins exhibit a skin eruption after the administra- 
tion of large medicinal doses of bromides. These eruptions 
usually take the form of acne papules or pustules and also of red 



2 28 INORGANIC DRUGS. 

blotches. Other kinds of skin lesions may occasionally be seen 
after their administration. 

Unlike the iodides, bromides seldom irritate the respiratory 
tract, yet, occasionally, a little bronchial, pharyngeal or nasal 
irritation, with increased secretion may be seen, after bromides. 
Through their excretion into the mouth, they may produce a 
disagreeable metallic taste; also an offensive breath. 

The heart is never affected by these drugs, when adminis- 
tered by the mouth. The term bromism has been applied when 
any of the untoward effects of bromides occur. All of these 
disappear rapidly when the drug is withdrawn. It is said that 
the taking of very large amounts of bromides for a long time, may 
induce a certain cachexia, which makes patients more likely to 
infectious diseases. 

IODIDES, unlike bromides, do not produce a well-marked 
pharmacological action on the central nervous system, but they 
have much greater action on the general metabolism. When 
given in large doses for a long period of time, they may lead to 
extreme emaciation and cachexia. Iodides also have a specific 
effect in stimulating the thyroid secretion, and in diseases with 
an increase of this secretion, as in exophthalmic goitre, they may 
cause alarming symptoms, such as excessive palpitation, great 
nervousness and sleeplessness and tremors. 

Like bromides, only much more intensely, iodides produce 
marked irritation at the place of absorption and place of excre- 
tion. With iodides, the respiratory tract suffers most; and very 
distressing coryza, running of the eyes, pharyngitis, laryngitis 
and bronchitis may occur after medicinal doses. Even oedema 
of the larynx, necessitating tracheotomy, has occasionally been 
observed in man. 

Skin eruptions following the use of iodides are also exceedingly 
common and may take the form of any of the skin lesions. 
These result in sensitive skins from the excretion of some of the 
iodides by the skin. 

Although excreted in large part by the urine, iodides do not 



GROUP OF NEUTRAL SALTS. 229 

seem to produce inflammation of the kidney, but they may cause 
irritation of the bladder, urethra and vagina. 

The stomach, particularly after oral administration, is es- 
pecially prone to irritation. Loss of appetite, nausea, vomiting 
and other dyspeptic symptoms are the frequent sequence of the 
administration of iodides. As in the case of bromides, these can 
be, to a certain extent, overcome by giving the iodides with an 
alkali, well-diluted with milk, after full meals. 

The most important, yet, unexplained action of iodides in 
practical medicine, consists in their marvelous curative action in 
the tertiary stages of syphilis. In this disease, they may cause 
the disappearance in a few days to a few weeks of large gummata 
and also of tertiary skin affections. 

Iodism is a term applied to the untoward effects of iodides. 

SUMMARY OF GROUP ACTION.— Salt action, producing 
with the easily di fusible members changes in the general metabolism, 
a solution of the mucus in the bronchi and stomach, and an increase 
in the secretion of urine. While with the more difficultly absorbed 
members, having specific stimulant properties on the mucosa of the 
intestines causing augmentation of peristalsis resulting in purgation, 
also special effects due to the ionic constitution of the salts observed 
on the central nervous system, heart and musculature after sub- 
cutaneous or intravenous administration with all salts and even after 
internal administration with some of them. 

THERAPEUTIC APPLICATION.— Some of the neutral salts, 
including sodium chloride, sodium sulphate and magnesium 
sulphate, are used in the treatment of stomach catarrhs. In these 
conditions, they probably exert their beneficial influence firstly 
by dissolving the mucus which covers the lining of the stomach 
and interferes with the secretion and admixture of the gastric 
juice with the food; secondly, through their local irritant action 
by increasing the peristalsis of the atonic stomach, thus relieving 
retention. 

Sodium chloride is also of value in increasing the peristalsis 
of the small intestines and dissolving mucus which may be there, 
but as it is rapidly absorbed it does not influence the large bowel. 



230 INORGANIC DRUGS. 

Since the members of the sodium sulphate group, including 
sodium sulphate, sodium phosphate and magnesium sul- 
phate act by increasing the peristalsis of the intestinal tract, they 
are used as purgatives. In small doses, they are employed to 
relieve constipation; in large ones to produce profuse watery evac- 
uations, and thus to rid the intestinal tract of obnoxious material, 
either poisons from the outside or irritative products of fermenta- 
tion. During their purgative action they draw the blood to the 
intestines and so may relieve the congestion in other organs such 
as the brain, liver, kidney, etc. By decreasing the watery con- 
stituents of the blood they may help the absorption of cedenias and 
e fusions. 

Since the members of the sodium chloride group are ab- 
sorbed and excreted by the kidneys, they may be used as diuretics 
and because of their excretion in the bronchi, as expectorants. 
As a diuretic, sodium chloride has been used especially in the form 
of mineral waters. To increase the bronchial secretion and to 
render the bronchial mucus less tenacious, potassium iodide is 
especially useful. 

All the salts of the sodium chloride type can be used to in- 
crease the general metabolism. Sodium chloride in the form 
of mineral waters is much employed for this purpose, but the 
most active members of the group on the nutrition are the 
iodides. They have been used to increase the metabolism in 
practically all conditions where it is believed to be faulty, as 
gout and rheumatism, but they have been found especially valu- 
able in the tertiary and secondary stages of syphilis. They are 
given with marvelous results to remove syphilitic gummata. 
They are also employed with considerable success for simple 
goitre; and in a number of cases, they have been found useful to 
remove certain lympho-sarcomatous glands. This action of dis- 
solving tumors of different natures cannot be explained alone by 
the increased metabolism due to their salt action. Possibly part 
of this effect is due to the formation of an easily soluble and ex- 
creted iodine compound between the iodine and the proteids 
of the tumor. 



GROUP OF NEUTRAL SALTS. 23 1 

Potassium iodide has also been used with some degree of 
success in the treatment of arteriosclerosis and aneurysm. In 
the cases where benefit occurred it is possible that this was due 
to the fall of blood pressure occasioned by the potassium element, 
and also to changes in the metabolism of the arterial walls. 

Bromides are used especially to decrease the functional 
activity of the central nervous system as in cases of nervousness, 
sleeplessness and epilepsy. Paradoxical as it may seem, since 
bromides have an irritant action upon the stomach, yet, if ad- 
ministered in the proper manner, they are often very valuable in 
gastric neuroses, acid gastritis and gastrospasm. In the last men- 
tioned disease, they are found to diminish both the intensity and 
the frequency of the attacks. If epilepsy is due to irritation of 
the cortex, this action may be explained by the influence of the 
bromides in depressing the motor areas of the brain. 

Potassium chlorate is used as a mouth wash and gargle in 
inflammation of the mouth and throat and also as an instillation 
in inflammation of the sigmoid and rectum. There, it probably 
acts only through its salt action as a mild antiseptic and by remov- 
ing excessive mucus. 

Potassium nitrate was formerly employed considerably, but 
now only seldom as a diuretic. 

Calcium phosphate and other phosphates were used in 
various bone diseases to replace the normal bone constituents, 
but since they are so poorly absorbed, they exert no such influence. 
In some osseous diseases even more calcium and phosphates may 
be excreted by the feces and urine than have been given in the food. 

MATERIA MEDICA. 

Non-purgative Division. 

Sodii Chloridum (U.S.P., B.P.), or common salt, white crystals, odor- 
less, with a salty taste. Very soluble in water, almost insoluble in alcohol. 
Dose : — 0.5 to 4.0 G. Br. (10-60 grains.) Average (U.S. P.), 16.0 G. 

Ammonii Chloridum (U.S.P., B.P.), white crystals, very soluble in 
water, insoluble in alcohol. It has a cooling, saline taste. Dose: — 0.5 to 
2.0 G. Br. (10-30 grains.) Average (U.S. P.), 0.5 G. 

Potassii Chloridum, white crystalline body, very soluble in water, and 
practically insoluble in alcohol. Dose : — 0.5 to 2.0 G. 



232 INORGANIC DRUGS. 

Lithii Chloridum, white crystals, very deliquescent, soluble in water. 
Dose: — 0.5 to 2.0 G. 

Sodii Bromidum (U.S. P., B.P.), white crystals having a saline, bitter 
taste. Very soluble in water. Soluble in 13 parts of alcohol. Dose : — 0.5- 
2.0 G. Br. (10-60 grains.) Average (U.S. P.), 1.0 G. 

Potassii Bromidum (U.S. P., B.P.), white crystals easily soluble in 
water but only in 180 parts of alcohol, disagreeable, salty bitter taste. 
Dose : — 0.5 to 2.0 G. Br. (10-60 grains). Average (U.S. P.), 1.0 G. 

Ammonii Bromidum (U.S. P., B. P.), colorless crystals, with a pungent, 
saline taste. Very soluble in water, soluble in 30 parts of alcohol. Dose : — 
0.5 to 4.0 G. Br. (10-60 grains). Average (U.S. P.), 1.0 G. 

Lithii Bromidum (U.S.P., B.P.), is a white, granular salt, bitter taste, 
very deliquescent, very soluble in water and alcohol. Dose : — 0.5 to 2.0 G. 
Br. (10 to 20 grains). Average (U.S. P.), 1.0 G. 

Calcii Bromidum (U.S. P.), white, granular, having a sharp saline taste, 
and very deliquescent. Very soluble in water and alcohol. Dose : — 0.5 to 
2.0 G. Br. (10 to 20 grains). Average (U.S. P.), 1.0 G. 

Strontii Bromidum (U.S. P.), colorless, crystalline body having a bitter, 
saline taste, very deliquescent, very soluble in water and alcohol. Dose : — 
0.5 to 2.0 G. Average (U.S. P.), 1.0 G. 

Sodii Iodidum (U.S. P., B.P.), colorless crystals, having a saline, bitter 
taste, very soluble in water, soluble in 3 parts of alcohol. Dose: — 0.5 
to 4.0 G. Br. (10 to 60 grains). Average (U.S. P.), 0.5 G. 

Ammonii Iodidum (U.S.P.), colorless crystals, sharp saline taste, very 
deliquescent, very soluble in water, soluble in 9 parts of alcohol. Dose :— 
0.5 to 4.0 G. Average (U.S.P.), 0.2 G. 

Potassii Iodidum (U.S. P., B.P.), colorless crystals, with a faint, iodine- 
like odor and a pungent, saline, bitter taste. Very soluble in water, soluble 
in 18 parts of alcohol, 2.5 parts of glycerine. Dose: — 0.5 to 4.0 G. Br. 
(10 to 60 grains). Average (U.S. P.), 0.5 G. 

Unguentum Potassii Iodidi (U.S. P.), contains 10 per cent, potassium 
iodide. 

Potassii Nitras (U.S. P., B.P.), or saltpeter, colorless, odorless crystals, 
having a cooling, saline taste, very soluble in water, very sparingly soluble in 
alcohol. Dose: — 0.25 to 1.0 G. Br. (5 to 15 grains). Average (U.S.P.), 
0.5 G. 

Charta Potassii Nitratis consists of paper dipped in 20 per cent, solu- 
tion of potassium, nitrate. 

Sodii Nitras (U.S. P.), (Chili saltpeter), colorless transparent crystals 
having a cooling, saline, bitter taste, deliquescent in air, very soluble in 
water, soluble in 100 parts of alcohol. Dose: — 0.3 to 2.0 G. Br. (5 to 15 
grains). Average (U.S. P.), 1.0 G. 

Potassii Chloras (U.S. P., B.P.), white crystal, saline, bitter taste, 
soluble in 20 parts of water. Dose: — 0.1 to 0.5 G. Br. (2 to 5 grains). 
Average (U.S.P.), 0.25 G. 

Purgative Division. 

Sodii Sulphas (U.S. P., B.P.), or Glauber's salt, large, colorless crystals, 
having an intensely bitter, saline taste, efflorescent in the air, very soluble in 
water, insoluble in alcohol. Dose: — 10.0 to 30.0 G. Br. (^ to 1 5). 
Average (U.S.P.), 16.0 G. 



GROUP OF PHOSPHORUS. 233 

Potassii Sulphas (U.S. P., B.P.), colorless crystals, with a bitter saline 
taste, soluble in 9.5 parts of water, insoluble in alcohol. Dose : — 5.0 to 15.0 
G. Br. (2 to 4 5). Average (U.S.P.), 2.0 G. 

Magnesii Sulphas (U.S. P., B.P.), Epsom salts, colorless crystals, with 
intensely bitter taste. Very soluble in water, insoluble in alcohol. Dose : 
— 10.0 to 30.0 G. Br. {y 2 to 1 5). Average (U.S.P.), 16.0 G. 

Sodii Phosphas (U.S. P., B.P.), colorless crystals, with a cooling, slightly 
saline taste, efflorescent in the air, soluble in 5 parts of water. Dose: — 
10.0t030.0G. Br. (KtoiB). Average (U.S.P.), 2.0 G. 

Potassii Bitartras (U.S. P.), Potassii Tartras Acidus (B.P.), or cream of 
tartar, colorless crystals, having a pleasant, acidulous taste, soluble in 201 
parts of water, difficultly soluble in alcohol. Dose : — 5.0 to 15.0 G. Br. (2 
to 4 5). Average (U.S.P.), 2. G. 

Potassii et Sodii Tartras (U.S.P.), Soda Tartarata (B.P.), or Rochelle 
salts, colorless crystals with a cooling saline taste, effloresces in the air. 
Easily soluble in water. Dose : — 10.0 to 30.0 G. Br. iyi to 1 5). Average 
(U.S.P.), 8.0 G. 

Pulvis Effervescens Compositus (U.S. P.), Purvis Sodae Tartaratae 
Effervescens (B.P.) or Seidlitz powder, composed of Rochelle salt, sodium 
bicarbonate and tartaric acid. Dose: — Average (U.S. P.) one set of two 
powders. 

Magnesii Sulphas Effervescens (U.S.P.), white, coarsely granular salt, 
with a mildly acidulous, refreshing taste. Deliquescent, easily soluble in 
water, almost insoluble in alcohol. Dose: — 10. o to 30.0 G. Average 
(U.S.P.), 16.0 G. 

Liquor Magnesii Citratis (U.S. P.), effervescent liquid, made by mixing 
magnesium carbonate, potassium bicarbonate and citric acid, corking and 
wiring immediately. Dose: — 50.0 to 250.0 c.c. Average (U.S. P.), 
360.0 c.c. 

GROUP OF PHOSPHORUS. 

YELLOW PHOSPHORUS is the active form, for its allotropic 
modification or the red variety is inert, on account of the absolute 
insolubility of the latter in body fluids. 

The yellow phosphorus itself is slowly absorbed on account 
of its difficult solubility, but there is an agent in the intestinal 
tract, bile, which greatly facilitates its solution and absorption. 
It probably enters the circulation in small quantities in the form 
of vapors, but only to a small extent as it is so little volatile at the 
temperature of the body. 

On account of its slowness of absorption, poisonous symp- 
toms may not appear for hours or even for a day after its inges- 
tion. These consist first of a burning sensation in the oesophagus, 
stomach and abdomen, followed by persistent nausea, sometimes 
bloody vomiting with garlicky odor and diarrhoea. They are 



234 INORGANIC DRUGS. 

followed in a few days by symptoms of great weakness, jaundice, 
distress and pain in the region of the stomach and liver, at first 
an increase, then a decrease in the secretion of urine, collapse 
and death. The pulse is weak throughout the poisoning and 
there may be also hemorrhages from the nose, uterus and sub- 
cutaneous tissues. The liver is usually felt much enlarged. 
Delirium and convulsions often precede the fatal ending in 
coma. 

The gastro-intestinal symptoms are due to protoplasmic 
changes of the cells of this tract, beginning with cloudy swelling, 
then resulting in fatty degeneration. The ecchymoses and 
hemorrhages are due to degeneration of the vessel walls. The 
pain over the liver, the jaundice, the great diminution of urea 
in the urine, the appearance of leucin, tyrosin and large quanti- 
ties of ammonia and lactic acid in this secretion are all due to in- 
terference with the functions of the liver on account of its destruc- 
tion by fatty degeneration. It is said that the autolytic proc- 
esses of the liver are increased and that these abnormal con- 
stituents in the urine are due to self-digestion of this organ. It 
is probable, however, that it is not the autolytic activity which is 
increased but the resistance of the cells against it which is de- 
creased. The preliminary increase in the urine is due to the aug- 
mentation of urinary products, but the succeeding interference 
with this secretion is due to fatty degeneration of the kidneys. 
This widespread fatty degeneration even attacks the vessel walls 
and the fibres of the skeletal muscles and heart. 

With this poison, the lower forms of organisms and ferments 
seem to remain unaffected, for bacteria are not killed or hindered 
in their activity. Peptic and pancreatic digestions and autolysis 
of organs go on just as well in the presence of phosphorus. 

When death takes place after a few days, it is due to the general 
destruction of the various organs and the consequent great in- 
terference with metabolism. When it occurs early in the 
first hours of the poisoning, it is then due to direct paralysis 
of the heart muscles. 

Phosphorus exerts little, if any direct effect upon the central 



GROUP OF PHOSPHORUS. 235 

nervous system, neither does it affect the irritability of nerve 
muscle preparations. 

Given in moderately small doses over a long period of time, 
phosphorus produces besides general cachexia and fatty de- 
generation of the different organs, a characteristic connective- 
tissue formation which may lead to cirrhosis of the stomach, 
liver or kidneys. 

Administered in minute doses for a long time to young ani- 
mals, it increases the cancellous structure of bones, converts 
cartilage and soft bone into hard bone. This osseous formation, 
as well as that of connective tissue, is probably due, at least 
in part, to a special stimulant action of phosphorus upon the 
cells. When its fumes are inhaled over a period of time, as by 
workers in match factories, besides cachexia, gastro-intestinal 
disturbance, anaemia and slight jaundice, marked evidences of 
its special action on bones may be seen. These, which are only 
observed when there are carious teeth, consist of necrosis of the 
jaw, leading to pus formation and throwing off of sequestra 
which, however, may heal perfectly with the formation of new 
bone. 

In small doses in man, phosphorus has been found to increase 
the number of red blood corpuscles, due to a stimulation of the 
bone marrow, but in poisonous quantities it destroys red blood 
globules in most animals. It circulates through the blood, acts 
in the body as such, and is not transformed into phosphuretted 
hydrogen. It is excreted partly as such by the lungs, partly 
as a proteid compound and to only a small extent as phosphates 
by the urine. 

Since phosphates are non-poisonous in the intestinal tract, 
various oxidizing agents are given as antidotes in phosphorus 
poisoning to oxidize the latter to phosphates. Some of these are 
potassium permanganate, hydrogen peroxide and turpentine; 
although these remedies are not as a rule very successful. Copper 
sulphate is also used because it produces an insoluble compound, 
but as this is again readily decomposed, it should be rapidly re- 
moved by emesis or purgation. 



236 INORGANIC DRUGS. 

PHOSPHURETTED HYDROGEN or PH 3 , is a colorless gas 
with the odor of garlic, which was formerly described as having 
the same action as phosphorus : in fact, some authorities believed 
that the latter acted in the body only after transformation into 
this gas. 

Phosphuretted hydrogen does not have the identical action 
of phosphorus, although it is exceedingly toxic and produces 
death quickly in doses of 0.002 G. in rabbits. Its action is 
chiefly on the central nervous system, heart and gastroin- 
testinal tract. After a stage of vomiting and diarrhoea it kills 
by paralysis of respiration and circulation. 

SUMMARY OF GROUP ACTION.— Absorption difficult, but 
may be aided by bile. When large quantities absorbed, rapid death 
due to paralysis of the heart. In slow poisoning, extensive fatty 
degeneration of all parenchymatous organs, including liver, kidney, 
'heart, skeletal muscles and arterial walls. At first vomiting and 
diarrhoea which becomes bloody. Urine diminished and contains 
amido acids, ammonia and but little or no urea. Delirium and con- 
vulsions precede death in coma. 

THERAPEUTIC APPLICATION.— Phosphorus has been 
used in various nervous affections and anaemia. Its chief field 
of application is to harden bone in diseases attended by a soften- 
ing of these organs as rickets and osteomalacia. Caries and un- 
united fractures are sometimes treated by the administration of 
phosphorus internally. 

Instead of phosphorus itself, various compounds of this element 
are used in its place for a tonic effect. These include hypophos- 
phites, glycerophosphates and a derivative of the latter, lecithin, a 
normal constituent of the brain. These have been used on the 
theory that many debilitated conditions are due to a decrease 
of phosphorus in the body and that these compounds are emi- 
nently suited to replace this waste. No definite pharmacological 
action nor therapeutic results have ever been proved to follow 
the use of these substances. 



GROUP OF SULPHUR AND SULPHIDES. 237 

MATERIA MEDICA. 

Phosphorus (U.S.P., B.P.), translucent, colorless, or slightly yellowish 
waxy mass which emits fumes with a garlicky odor. Very soluble in carbon 
disulphide, sparingly soluble in alcohol, ether, fats, ethereal oil and bile, 
but almost insoluble in water. It emits luminous vapors in the dark and 
catches fire spontaneously. Dose: — 0.0005 to 0.001 G. Br. (eV to T <yo 
grain). Average (U.S. P.), 0.0005 G. 

Pilulae Phosphori (U.S.P.), each pill contains 0.0006 G. of phosphorus. 
Dose: — 1 to 2 pills. Average (U.S. P.), 1 pill. 

Oleum Phosphoratum (B.P.), contains 1 per cent, phosphorus in oil of 
almond. Dose: — 0.005 to °- 01 c - c - Br. (| to to tt#). 



GROUP OF SULPHUR AND SULPHIDES. 

This group contains SULPHUR, HYDROGEN SULPHIDE 
and the ALKALI SULPHIDES. 

SULPHUR itself has no action whatsoever, as it is insoluble in 
the fluids of the body and is consequently not absorbed. When 
given by the mouth or applied locally in the form of ointments, 
it is slowly transformed with the formation of hydrogen sulphide 
and alkali sulphides so that its action is entirely dependent upon 
these. 

In the gastro-intestinal tract, their irritant effect causes an 
increased peristalsis with mild purgation. The stools are, as a 
rule, mushy and seldom liquid because the sulphides which are 
the active agents are formed very slowly from sulphur. On the 
skin in the form of ointment the latter acts as a stimulant and 
also as an antiseptic and parasiticide. 

HYDROGEN SULPHIDE produces marked local irritant ac- 
tion which, when inhaled, may lead to burning of the eyes with 
formation of tears, running of the nose, pharyngitis, bronchitis 
and even oedema of the larynx. 

Besides the local irritant effect, this gas produces severe con- 
stitutional poisoning referable to an action on the central 
nervous system. In fact, one part in 5000 of air may produce 
alarming effects. 

After it is inhaled in sufficient quantity, it produces narcosis 
due to a depression of the brain and death from paralysis of 
respiration. In some cases death takes place almost immediately, 



238 INORGANIC DRUGS. 

while in others, it succeeds after a few hours of narcosis and is 
frequently preceded by violent convulsions. The latter may 
occur in both mammals and frogs and are probably due to irri- 
tation of the brain, at least in the warm-blooded. 

Workmen in sewers or chemists in laboratories occasionally 
show mild symptoms of hydrogen sulphide poisoning: these 
consist chiefly of dizziness, headache, somnolence and general 
weakness. 

After administration by the mouth, it is only absorbed slowly 
and since it is rapidly oxidized to sulphates enough is never present 
in the blood at one time to produce severe poisoning. A small 
amount, however, is excreted as hydrogen sulphide by the 
breath, and imparts to the latter a disagreeable odor. It is a 
strong protoplasmic poison and easily kills the lower forms of 
organisms both vegetable and animal. 

The ALKALI SULPHIDES produce the same effects as hydro- 
gen sulphide, but in addition they are also strong alkaline caustics. 
They dissolve horny tissues, especially the upper layers of epi- 
dermis and the hairs. Large quantities injected intravenously 
transform haemoglobin to sulpho-methaemoglobin, a compound 
which imparts to the blood a dark brown color with a greenish 
hue. 

They depress the central nervous system just as hydrogen 
sulphide, and after narcosis and convulsions produce death from 
paralysis of the medulla. They, however, do not seriously affect 
the heart. Like the latter, they are chiefly oxidized to sulphates 
and excreted as such by the urine, yet a small portion leaves by 
the lungs in the form of hydrogen sulphide. 

SUMMARY OF GROUP ACTION.— Local caustic, irritant and 
antiseptic action. In the intestines cause laxative effect. On skin 
produce stimulation and kill parasites. Nearly all the central 
nervous system depressed and death due to medullary paralysis. 
Convulsive centres in brain may be stimulated. 

THERAPEUTIC APPLICATION.— Sulphur itself is used in- 
ternally as a laxative in piles, constipation, etc., on account of the 
local irritant action of the hydrogen sulphide and alkaline sul- 



GROUP OF SULPHUR AND SULPHIDES. 239 

phides evolved. It is mild because these are formed but slowly, 
and, therefore, it produces only soft mushy stools, but not violent 
purgation. 

It is used locally in the form of an ointment, as an antiseptic 
against scabies and other skin parasites, also as a stimulant in in- 
dolent forms of dermal affections. 

Potassium and calcium sulphides are used mainly as ex- 
ternal caustics. The latter are sometimes used internally for cer- 
tain skin diseases. Both are employed in preparations used for 
removing superfluous hair. 

Hydrogen sulphide was formerly injected into the rectum for 
pulmonary tuberculosis with the hope that during the excretion 
by the lungs it would kill the organisms. This method of treat- 
ment has not proved successful and is exceedingly disagreeable. 
It is used externally in the form of sulphur baths for rheumatism 
and other chronic diseases. 

MATERIA MEDICA. 

Sulphur Sublimatum (U.S.P., B.P.), or sublime sulphur, fine, yellow 
powder, having a slight odor, insoluble in water, almost insoluble in alcohol, 
but soluble in benzine. 

Sulphur Praecipitatum (U.S.P., B.P.), or precipitated sulphur, fine, 
amorphous powder, lighter than the above. Same properties. 

Sulphur Lotum (U.S. P.), or washed sulphur, fine yellow powder, same 
properties as the above. Dose: — Of sulphur 1.0 to 5.0 G. Br. (15 to 45 
grains). Average (U.S. P.), 4.0 G. 

Unguentum Sulphuris (U.S.P., B.P.), contains 15 per cent, sulphur. 

Calx Sulphurata (U.S. P., B.P.), contains about 60 per cent, calcium sul- 
phide. It is a pale, greyish powder, with a faint odor of hydrogen sulphide, 
having an alkaline taste. Gradually decomposed by exposure to the air. 
Very slightly soluble in water, insoluble in alcohol. Dose : — 0.005 to 0.05 G. 
Br. (to to 1 grain). Average (U.S. P.), 0.065 G. 

Potassa Sulphurata (B.P.), or fiver of sulphur, composed of a mixture of 
potassium sulphide and potassium hyposulphite. It consists of irregular 
pieces of a liver-brown color which absorb oxygen and carbon dioxide on 
exposure to the air, and change to a greenish-yellow, and finally to a greyish 
mass. It has a faint odor of hydrogen sulphide, and a bitter, alkaline taste. 
It is soluble in 2 parts of water. 

Sulphuris Iodidum (U.S.P.), brittle masses, greyish-black color, with a 
metallic lustre, having the odor of iodine and an acrid taste. Almost in- 
soluble in water. Dose : — 0.05 to 0.2 G. 



240 INORGANIC DRUGS. 

COMPOUNDS OF HEAVY METALS. 

When solutions of the heavy metals are brought into contact 
with albumins, they form together a precipitate of the latter. 
With some, as copper and zinc, this precipitate is tough, dense 
and insoluble; with others, as mercury, arsenic and gold, it is 
less tough and easily redissolved in an excess of albumin. 

Those metals which form insoluble albuminates only destroy 
the cells in strong solution by coagulating their albumin and, 
therefore, act as superficial caustics, but in dilute solution they are 
powerful astringents. On the other hand, those which form sol- 
uble compounds with proteids penetrate deeply into the tissue 
and form deep caustics, but not astringents. 

Although the main part of the action of a metallic salt is due to 
the dissociated metal or metalic oxide ions, yet the salts with the 
stronger acids owe a part of their action to the dissociated acid 
ions. 

The salts of the metals, with some of the organic acids and other 
compounds which are difficultly dissociated, have very weak 
action, while those in combination with strong acids, as nitric, 
hydrochloric and sulphuric, may act as strong caustics, partly 
on account of the strength of the liberated acid and partly be- 
cause these compounds are easily dissociated. 

All metallic salts are antiseptics. This action is mainly due to 
the affinity of the metal for the albumin constituent of bacterial 
cells. 

With few exceptions, metals are difficultly absorbed from the 
gastro-intestinal tract ; so that poisoning after the ingestion is due 
to inflammation or corrosion of the alimentary canal. The fol- 
lowing exceptions are arsenic which is absorbed and which 
causes both severe, acute and chronic constitutional symptoms; 
lead and mercury which can produce, after their absorption, 
marked subacute and chronic constitutional symptoms. The 
others are absorbed in traces, but not in sufficient quantities to 
give rise to general symptoms. 

The metals are slowly excreted by the gastro-intestinal mucous 



GROUP OF ALUMINUM. 24 1 

membranes, liver and kidneys, as albuminates. They may, as 
copper and silver, become stored up in organs for life. 

When injected directly into the circulation in the form of double 
salts or soluble albuminates, all metals produce gastro-intestinal 
symptoms, also stimulation or depression of the central nervous 
system and heart, and irritation of the excretory organs which are 
mainly the gastro-intestinal tract and the kidneys. 



GROUP OF ALUMINUM. 

Although not a heavy metal, ALUMINUM is best grouped in 
this series on account of its pharmacological action. 

When brought in contact with a denuded surface or with a 
mucous membrane, aluminum preparations precipitate a tough 
layer of aluminum albuminate ; thus they act strongly as astrin- 
gents, i. e., they check secretions and contract the vessels. 
Like all agents of this class, if applied in too concentrated form 
or over a prolonged period of time, they produce irritation and in- 
flammation. 

The poisoning after ingestion by the mouth, is due only to the 
local irritant action upon the mucous membranes of the gastro- 
intestinal tract, and consists of symptoms of gastro-enteritis. 
Aluminum salts are not absorbed by the stomach and intestines 
so that they do not produce constitutional poisoning even after 
taking internally for months. They are never found in the urine 
and cause no change in the metabolism. 

When given subcutaneously or intravenously in the form of 
double salts, aluminum does not produce any symptoms before 
three or four days. These consist of great weakness, tremors, 
clonic convulsions, then paralysis of the limbs, somnolence, albu- 
minuria, vomiting and great loss of weight, at first obstinate 
constipation, usually followed just before death by diarrhoea. 

The symptoms are due to a stimulation of certain parts of the 
central nervous system followed by paralysis of the same, secon- 
dary to a degeneration of the nerve cells and fibres of the medulla 
and cord and to the irritation at the places of excretion, the gas- 
16 



242 INORGANIC DRUGS. 

tro-intestinal tract and kidneys. Both these and the liver may 
also show signs of fatty degeneration. 

TIN, like aluminum, is not absorbed from the unbroken mucous 
membrane, and has no constitutional action after internal ad- 
ministration. When given intravenously or subcutaneously in 
the form of double salts, it causes, in two to three days, symp- 
toms of general weakness; then convulsions, vomiting, diarrhoea 
and death follow in two or three more days from paralysis of the 
central nervous system. Tin poisoning in man is unknown, 
therefore there is no danger in the use of kitchen utensils made 
of this metal. 

MOLYBDEN, TUNGSTEN, VANADIUM, BERYLLIUM and 
URANIUM induce only the ordinary metallic poisoning in ani- 
mals. In addition uranium causes glycosuria and diminution in 
bodily oxidation. 

SUMMARY OF GROUP ACTION.— Strong local astringent ef- 
fect due to the formation of insoluble compounds with proteids. Not 
absorbed by the gastro-intestinal tract. No constitutional poisoning 
after administration by this channel. After intravenous injection 
symptoms of paralysis of central nervous system due to degeneration 
of the same and also irritation and degeneration of the gastro-intes- 
tinal tract where aluminum is excreted. 

THERAPEUTIC APPLICATION.— The main uses of alum- 
inum preparations are as astringents, hemostatics and antiseptics 
over wounds and inflamed mucous membranes, as those of the 
vagina, urethra, rectum, mouth, and pharynx. 

Alum and aluminum hydrate are sometimes used internally in 
small doses to check diarrhoea, and in large ones as emetics. 

MATERIA MEDICA. 

Alumen (U.S.P., B.P.), or aluminum and potassium sulphate, or alum, 
colorless crystals, having a sweetish and strongly astringent taste. Soluble 
in 9 parts of water, insoluble in alcohol. Used externally in Y A to 3 per cent, 
solutions. Dose:— 0.3 to 1.0 G. Br. (5 to 15 grains). Average (U.S.P.), 
0.5 G. 

Alumen Exsiccatum (U.S. P.), or burnt alum. White granular powder, 
without odor, but with a sweet astringent taste, and hygroscopic in the air. 
Slowly soluble in 20 parts of water. Dose : — 0.3 to 1.0 G. 



GROUP OF COPPER AND ZINC. 243 

Alumini Hydras (U.S. P.), a white, amorphous powder, odorless and 
tasteless, permanent in the air, insoluble in water and alcohol. Dose: — 
0.3 to 1.0 G. 

Alumini Sulphas (U.S. P.), white, crystalline powder, without odor, with 
a sweetish astringent taste. Soluble in 1.2 parts of water, almost insoluble 
in alcohol. Used externally in % to 3 per cent, solution. 

Alumini Chloridum, white crystals, soluble in water and alcohol, hy- 
groscopic and unstable, liberates hydrochloric acid. 

Alumnol, betanapthol disulphonate of aluminum, white powder, soluble 
in water used in yi to 3 per cent, solution. 



GROUP OF COPPER AND ZINC. 

Locally upon mucous membranes or denuded surfaces, solu- 
tions of COPPER and ZINC form a superficial layer of difficultly 
soluble albuminous compounds and, therefore, act as astringents. 

The salts with the stronger acids, which are easily dissociated, 
act in greater concentration as irritants and caustics. 

Both the sulphates of copper and zinc have a strong local action 
but the chlorides of both are still more active and especially 
that of zinc. On the other hand the albuminous combinations 
of these metals and the oxide and carbonate of zinc which are 
soluble with difficulty, have a much less marked local effect. 

After internal administration of large doses of soluble salts, 
the symptoms are those of gastro-intestinal irritation, i. e., 
vomiting, purging which may be bloody, and violent pain in 
the abdomen. Death takes place in collapse from the severity 
of the inflammation of the alimentary canal, and the mucous mem- 
brane of the latter shows great congestion and ecchymoses. 
With moderate doses, however, these serious symptoms do not 
occur, especially with sulphates as they cause emesis before in- 
flammation begins and are quickly removed. This vomiting, 
which is almost constant, is due to direct irritation of the gastric 
mucous membrane because it does not occur after subcutaneous 
administration. 

Although the salts of both copper and zinc are absorbed by 
the stomach and bowels, yet they never produce constitutional 
poisoning after ingestion as they are rapidly removed from the 
blood by different parenchymatous organs, especially the liver, 



244 INORGANIC DRUGS. 

but also the kidneys, spleen and thyroid. This takes place 
quicker than the absorption which diminishes in proportion to 
the size of the dose. A certain quantity of copper may remain 
stored in the liver for many years and in fact, it is often regarded 
as a normal constituent in minute quantities. 

Both metals are excreted by the bile, urine, salivary, gastric 
and intestinal secretions ; copper is chiefly eliminated by the liver 
and kidneys while zinc prefers the alimentary tract. 

Administered subcutaneously or intravenously as double com- 
pounds, they produce paralysis of the central nervous system, 
heart and striated muscles. Copper acts much more energetically 
on the two latter but zinc, on the other hand, depresses more 
the former. Both form special compounds with the haemoglobin 
of the blood called cupro-haemol and zinc-haemol. In fact, in 
some of the lower animals copper is found normally instead of 
iron combined with their blood coloring matters, and in most 
animals, it is found in traces as a normal constituent of the liver. 

If death does not take place immediately from the action on the 
vital organs, irritation of the excretory channels, as the gastro- 
intestinal tract and kidneys, may be observed, and with zinc, 
vomiting may even occur after subcutaneous administration 
on account of the inflammation of the stomach resulting from 
the metal there excreted. 

No true chronic constitutional poisoning occurs from 
either metals even if the dose ingested is large. The only symp- 
toms observed are those referable to long-continued irritation 
of the gastro-intestinal tract and consist of a decrease of appetite, 
nausea, vomiting and diarrhoea. Sometimes these have been 
seen in workmen in brass factories and in other individuals after 
eating canned peas or beans containing copper to preserve the 
green color of the chlorophyl. From inhaling the dust of either 
metal occasionally, laryngitis, pharyngitis and bronchitis may 
be produced. In people working with zinc sometimes a strange 
condition called brassfounder's ague develops. This consists of 
soreness of the chest, coughing, general malaise, pain throughout 
the body, and also chills followed by a rapid heart beat. The 



GROUP OF COPPER AND ZINC. 245 

patient after breaking out into perspiration goes to sleep and 
wakes up perfectly well. Copper often imparts a greenish tinge 
to the hair, skin and gums of workers. 

Some plants, as grape-vines, are benefited by the application 
of copper. On the other hand, many lower forms, as bacteria, 
tubifex and tadpoles are killed by a very minute amount. Copper 
is said to be a good antiseptic in less than 1 per cent, solution. 

Cadmium salts differ but little from those of zinc in their 
action. 

SUMMARY OF GROUP ACTION.— In dilute solutions, astrin- 
gent action, but in concentrated form, caustics. Internal adminis- 
tration gives rise to vomiting and at times to gastro-enteritis but never 
constitutional poisoning. Absorbed slowly by alimentary canal and 
separated from the blood by liver, spleen, kidneys and thyroid. 
Form compounds with hcemoglobin. After intravenous injection, 
paralysis of central nervous system, heart and muscles. Poisonous 
to many lower forms, therefore, antiseptics. 

THERAPEUTIC APPLICATION.— Salts of copper and zinc 
are used in dilute solutions mainly as astringents, hemostatics and 
antiseptics over inflamed mucous membranes and denuded sur- 
faces, especially in gonorrheal inflammations of the urethra and 
vagina. 

They are employed in concentrated solutions or in the solid 
forms as caustics over exuberant granulations and to destroy new 
growths. Zinc chloride, which is often one of the main constit- 
uents in so-called " cancer cures," has now been used with a 
good deal of success in legitimate practice as a caustic to treat 
cancer of the neck of the uterus. It does not produce a cure but 
may prolong life. 

Zinc and copper sulphate were used in the past in small doses 
as astringents in diarrhcea, but have nowadays been replaced by 
the newer tannin preparations. 

They were also employed in large doses on account of their 
irritant action as emetics, but have been superseded by apo- 
morphine. 



246 INORGANIC DRUGS. 

MATERIA MEDICA. 

Cupri Sulphas (U.S.P., B.P.), blue vitriol, transparent blue crystals, 
with a nauseous metallic taste, soluble in 2.6 parts of water, almost insoluble 
in alcohol. Used externally in to to % per cent, solution. Dose: — 0.1 to 
1.0 G. Br. (2-15 grains). Average (U.S. P.), astringent 0.01 G., emetic 
0.25 G. 

Zinci Sulphas (U.S.P., B.P.), white, odorless crystals with an astringent, 
metallic taste, soluble in water, insoluble in alcohol. Used externally in 
its to ]A per cent, solution. Dose: — 0.5 to 2.0 G. Br. (3-30 grains). 
Average (U.S.P.), 1.0 G. 

Zinci Chloridum (U.S.P., B.P.), white granular powder, intensely 
caustic properties, very astringent metallic taste, very deliquescent, very 
soluble in water and alcohol. 

Liquor Zinc Chloridi (U.S.P., B.P.), contains 36 per cent, by weight of 
chloride of zinc. 

Zinci Oxidum (U.S.P., B.P.), amorphous white, tasteless powder, in- 
soluble in water and alcohol. Dose, Br. (2-10 grains). Average (U.S.P.), 
0.25 G. 

Unguentum Zinci Oxidi (U.S.P.), contains 20 per cent, and Unguentum 
Zinci (B.P.), contains 15 per cent, of zinc oxide. 

Zinci Acetas (U.S. P., B.P.), white crystals, having a faintly acid odor 
and astringent, metallic taste. Soluble in 2.7 parts of water, in 36 parts of 
alcohol. Dose, Br. (1-3 grains). Average (U.S.P.), 0.125 G. 

Zinci Valeras (U.S. P.), Zinci Valerianas (B. P.), white, pearly scales with 
the odor of valerianic acid, and a sweetish, astringent, metallic taste. Solu- 
ble in 100 parts of water and 40 parts of alcohol. Dose : — 0.05 to 0.3 G. 
Br. (1-3 grains). Average (U.S.P.), 0.125 G. 



GROUP OF BISMUTH. 

Almost all the salts of BISMUTH used in medicine are insolu- 
ble in water, but some of these become gradually decomposed in 
contact with the tissues of the body upon which they exert an 
astringent action, both in virtue of the metallic and of the acid 
constituents. The most commonly used compound of bismuth, 
the subnitrate, causes this astringent effect partly through the 
liberated nitric acid which is even formed in watery suspension 
without contact with living tissues. The decomposition is slow, 
therefore the action is mild and prolonged. 

Insoluble bismuth preparations are only slowly absorbed from 
the gastro-intestinal tract so that in moderate doses constitu- 
tional poisoning does not occur after ingestion. Being insoluble 
and so slowly dissociated, they can hardly be given in concentra- 
tion great enough by the mouth to cause gastro-intestinal irrita- 



GROUP OF BISMUTH. 247 

tion. There are reasons to believe that bismuth preparations 
stimulate the secretion of gastric mucus and this might explain 
their good effect in hyperacidities of the stomach. In these con- 
ditions where the normal protective alkaline mucus is thought to 
be deficient, it would be restored, and at the same time the too 
acid gastric juice would be partly neutralized by the alkaline 
mucus. 

In individuals with diarrhoea, they often stop this symptom. 
They always darken the stool to a slate brown color. This con- 
dition is due to the formation of the sulphide and oxide of bismuth. 

Numerous cases of poisoning formerly reported after the 
internal administration of bismuth preparations have been 
found to be due to arsenic, antimony and lead formerly found as 
impurities in bismuth preparations. The bad odor of the breath 
which they cause is due to traces of tellurium. When applied to 
wounds or to serous surfaces, absorption of bismuth seems to be 
better and constitutional poisoning has occurred occasionally in 
human beings. It consists of inflammation of the entire ali- 
mentary tract, stomatitis, ulceration and swelling of the gums 
and tongue, pharynx, oesophagus, marked inflammation and even 
ulceration of the stomach, especially of the large intestines and 
caecum, also albuminuria, due to inflammation of the kidneys. 
On account of these conditions, there is pain on swallowing and 
also tenderness of the abdomen, and colic, vomiting and diarrhoea, 
as after any gastro-intestinal irritation. 

Since the use of bismuth subnitrate in large quantities for x-ray 
examination of the gastro-intestinal tract, there have been num- 
erous cases of poisoning and a few deaths reported from poisoning 
by this salt. Investigation has shown that the subjects suffered 
from methemoglobinemia and that the cause of this was not due 
to the bismuth but to the acid radical. In other words, the 
nitric acid radical in bismuth subnitrate was reduced to the nitrite 
radical and nitrite poisoning occurred. 

This nitrite poisoning has also been met after the rectal in- 
jection of bismuth subnitrate and is explained by the presence 
of reducing bacteria in the intestines. This has been found, par- 



248 INORGANIC DRUGS. 

ticularly in diarrhceal trouble and in children's feces. The moral 
to be deducted is that we should use in preference to the sub- 
nitrate, some other salt of bismuth, as the subcarbonate. In 
#-ray work, some who still believe that the poisoning results 
purely from the bismuth ion, use instead barium sulphate or 
magnetic iron oxide. 

The alimentary canal, particularly the large intestines, caecum 
and the kidneys are especially prone to the poisonous effects of 
bismuth, because they are its chief organs of excretion. Yet 
a certain amount is separated by the liver and stored there for a 
time. This may explain the absence of poisoning after ingestion. 

When double salts of bismuth are injected subcutaneously 
and intravenously in sufficient quantities, the symptoms are those, 
at first, of stimulation of the cord and medulla, attended with 
convulsions, succeeded by paralysis of these parts and death due 
to respiratory and heart failure. 

The injection of repeated small doses in animals produces 
the same subacute or chronic poisoning seen in man after acci- 
dental absorption. 

TELLURIUM and SELENIUM have in general the character- 
istic action of the heavy metals. They produce by subcutaneous 
injection, irritation of the gastro-intestinal tract and kidneys, 
and paralysis of the central nervous system and heart. When 
taken internally, even in traces, they impart to the breath a 
garlicky odor. The salts are reduced in the body to the metallic 
state and then combined with methyl in the form of volatile 
odorous compounds which are excreted by the lungs, kidneys 
and intestinal tract. 

Tellurates paralyze the ending of the sweat glands like atro- 
pine and agaric acid. 

SUMMARY OF GROUP ACTION.— Insoluble salts become 
gradually decomposed in contact with living tissues and by virtue of 
both the basic and acid ions act as astringents and antiseptics. Al- 
most unabsorbed by oral administration, therefore, seldom poisonous 
action even with large internal doses, except from nitrate salts which 
cause nitrite poisoning. Absorbed much more readily from serous 



GROUP OF BISMUTH. 249 

surfaces as joints, and symptoms of marked gastro-intestinal and 
renal irritation may ensue because of excretion by kidneys and 
bowels. When injected into circulation, produce first stimulation 
then depression of the central nervous system. Death results from 
paralysis of respiration and circulation. 

THERAPEUTIC APPLICATION.— Bismuth salts are used 
in inflammatory and ulcerative conditions of the stomach and in- 
testines : the good effect in such cases is due to the astringent plus 
the protective effect. The latter comes from the formation of a 
coating over the ulcer, by virtue of the insolubility of the salts 
commonly in use. 

They have been used as astringents in catarrhal inflammations 
of practically all mucous membranes as those of the urethra, 
vagina and gastro-intestinal tract and are of great value in ar- 
resting diarrhoea. They are also of value in skin diseases in the 
form of ointments. 

The subnitrate, but especially the other salts of bismuth with 
antiseptic radicles as naphthol, phenol and salicylic acid, are used 
as disinfectants of the gastro-intestinal tract. 

The subcarbonate is the best salt to use in gastric affections, 
while the salicylate, naphtholate, etc., are mofe valuable as in- 
testinal antiseptics. The subnitrate should never be used in 
huge doses for fear of nitrite poisoning. 

MATERIA MEDICA. 

Bismuthi Subnitras (U.S. P., B.P.), white, heavy, odorless, tasteless 
powder, insoluble in water and alcohol. It becomes gradually decomposed 
in watery suspension with the liberation of free nitric acid. Dose: — 0.5 
to 3.0 G. up to 30.0 G. in 24 hours. Br. (5-30 grains). Average (U.S. P.), 
0.5 G. 

Bismuthi Subcarbonas (U.S.P., B.P.), white, heavy, odorless, tasteless 
powder, insoluble in water and alcohol. Dose: — 0.5 to 3.0 G., up to 30.0 
G. in 24 hours. Br. (5-30 grains). Average (U.S.P.), 0.5 G. 

Bismuthi et Ammonii Citras (U.S. P.), white scales, with a metallic 
taste, very soluble in water, soluble in alcohol. Dose: — 0.1 to 0.3 G. 
Average (U.S.P.), 0.125 G. 

Bismuthi Citras (U.S. P.), a white powder, insoluble in water, and al- 
cohol. Dose: — 0.05 to 0.2 G. Average (U.S. P.), 0.125 G. 

Bismuthi Subgallas (U.S. P.), or dermatol, yellow, odorless powder, 
insoluble in water and alcohol. Dose: — 0.1 to 0.2 G. Average (U.S. P.), 
0.25 G. 



250 INORGANIC DRUGS. 

Bismuthi Subsalicylas (U.S.P.), Bismuthi Salicylas (B.P.), cream 
colored powder, insoluble in water and alcohol. Dose: — 0.5 to 3.0 G. up 
to 30 G. in 24 hours. Br. (5 to 30 grains). Average (U.S.P.), 0.25 G. 

Bismuthi Betanaphtholas or Orpholum, greyish powder with un- 
pleasant taste and odor of naphthol, containing 74 per cent, bismuth. Dose : 
— 1.0 G. 

Bismutose (bismuth albuminate), white, insoluble powder without odor 
and taste. Contains 22 per cent, bismuth. Dose: — 1.0 to 2.0 G. 

Bismon (colloidal bismuth). Compounds of lysalbinic and protalbinic 
acids with oxides of bismuth. Soluble in hot and cold water, giving yellow- 
ish-red opalescence. Contains 25 per cent, bismuth. 

Xeroform (bismuth tribromphenol), yellow powder containing 60 per 
cent, bismuth, insoluble in water. Dose : — 0.5 G. 



GROUP OF LEAD. 

LEAD is one of the few metals which produces constitutional 
symptoms after internal administration. These are always chronic 
in nature, because they are due to the gradual accumulation 
of the metal in the system on account of its more rapid absorp- 
tion than excretion. They result as a rule from the adminis- 
tration of small doses of any lead salts over a certain period of 
time, and but rarely follow the ingestion of one large dose. 

The absorption, although slow, is more rapid than that of any 
other metal, except mercury. Even the most insoluble sulphate 
and metallic lead become slowly dissolved and absorbed by the 
alimentary canal. The latter is probably the chief channel of 
absorption, although wounds and mucous membranes of the 
urethra and vagina may take up enough to cause a constitutional 
action. The unbroken skin probably does not absorb lead 
preparations and the poisoning seen in painters is due to handling 
food with uncleanly hands and also to the entrance of the lead 
paint into cuts or abrasions. 

Locally applied in not too concentrated form to abraded sur- 
faces or mucous membranes, solutions of lead salts, as the ace- 
tates, form a dense precipitate of albuminate and thus act as 
astringents and hemostatics. On account of their affinity for 
albumin, they act as antiseptics but not as much as many other 
metals, probably because the lead ions are not so poisonous to 



GROUP OF LEAD. 251 

lower forms. Concentrated solutions of easily dissociated lead 
salts act as irritants but rarely as caustics. 

Large doses given by the mouth produce the ordinary symp- 
toms of gastro-enteritis , consisting of nausea, vomiting, pain in 
the bowels, diarrhoea and at last collapse. The vomiting and 
diarrhoea may be profuse and bloody. Occasionally, chronic 
poisoning has resulted in persons who recovered from the acute 
inflammation of the alimentary canal. 

Small doses given over a long period of time produce a chronic 
condition of poisoning characterized by irritation of the ali- 
mentary canal, kidneys, central and peripheral nervous and 
muscular systems. These symptoms of stimulation are followed 
by depression and degeneration of all those different organs. It 
also produces changes in the blood resulting in anaemia and in the 
general metabolism causing gout. Among the first symptoms of 
chronic lead poisoning are those referable to the gastrointes- 
tinal tract. It is not surprising, as this tract comes most in con- 
tact with the metal, both during absorption and excretion. It 
leaves the body by the saliva, bile, intestinal mucous membranes 
and kidneys. These symptoms consist of a metallic taste in the 
mouth, fetid breath, sometimes a blue line on the gums, loss of 
appetite, nausea, vomiting, tenderness of the abdomen, and char- 
acteristic attacks of colics usually accompanied with constipation, 
rarely with diarrhoea. 

The effect on the mouth is due to its excretion by the saliva. 
The gastric symptoms result from the local action of lead on the 
stomach mucous membrane. The latter may even at times show 
fatty degeneration and connective tissue proliferation. 

The colics are paroxysmal, very severe, and often relieved 
by firm pressure and by atropine. They are due mainly to a 
powerful spasmodic contraction of the smooth muscles of the 
intestines dependent upon the stimulation of their nerve supply. 
The fact that they are relieved by atropine supports this view. 

On account of the contraction of the intestines, the vessels of 
the splanchnic area are squeezed so that they hold less blood and, 
therefore, the general blood pressure rises. Either due to this 



252 INORGANIC DRUGS. 

increased pressure in the arterial system or to direct action of the 
lead on the vessel parenchyma, arteriosclerosis often results from 
chronic lead poisoning. The kidneys, which excrete part of 
the lead, also undergo degeneration mainly of a mixed paren- 
chymatous and interstitial type. 

The brain at times shows changes, sometimes of simulation, 
as sleeplessness, headaches, epileptic and choreiform seizures, 
maniacal delirium, hallucinations, sometimes symptoms of de- 
pression, as great weakness and stupor. 

The peripheral nerves also show signs of irritation in the form 
of severe lancinating pains about the joints. The long-continued 
inflammation of the peripheral nerves leads to their degeneration 
and paralysis. It is especially apt to affect those going to the 
extensors, so the characteristic " wrist-drop" (inability to hold 
up the hand), is often seen resulting from paralysis of the ex- 
tensors of the arm which are affected sooner than the flexors. 

Anaesthesia of the skin occurs from degeneration of the sensory 
nerves. Blindness occasionally results from optic atrophy. 
Deafness which sometimes occurs, is probably also due to changes 
in the specific nerve of hearing. 

The muscles also become affected and lose the irritability 
to induced currents but react more strongly to direct ones, thus 
showing the reaction of degeneration. 

When suitable preparations of lead are injected into the cir- 
culation of animals, the symptoms are referable to many of the 
organs which are affected in human beings in chronic poisoning. 
They consist of irritation of the gastro-intestinal tract with the 
characteristic colics, muscular paralysis and the cerebral changes 
giving rise to tremors, epileptiform convulsions and also mental 
apathy. 

Acute poisoning from lead is treated by neutralizing the 
poison in the gastro-intestinal tract with dilute sulphate solutions 
in order to make an insoluble salt which is then removed by 
washing out the stomach and by purging, for if this is not done 
it will gradually become absorbed. White of egg is also useful 
on account of the nearly insoluble albuminate which is formed. 



GROUP OF LEAD. 253 

Chronic poisoning is usually treated by detecting and re- 
moving the source of contamination. The elimination is fur- 
thered by the administration of potassium iodide and different 
diuretics and laxatives. Atropine is given to relieve the colics. 
The anaemia is corrected by iron and the general health is im- 
proved by every method at hand. If irritated brain symptoms 
are present, they may be checked by narcotics. Paralysis may 
be treated with strychnine, massage and electricity. 

THALLIUM salts resemble in their action those of lead but are 
more poisonous. They are said to produce special atrophy of the 
muscles in animals and baldness in man. 

SUMMARY OF GROUP ACTION.— Local effect, astringent. 
After internal administration of a large dose, the symptoms consist 
of acute gastro -enteritis. When small amounts are ingested over 
a period of time, symptoms are irritation of the gastro-intestinal 
tract with loss of appetite, nausea, vomiting and colics, with obstinate 
constipation, peripheral neuritis with pain and paralysis, " wrist 
drop," cerebral symptoms, degeneration of blood vessels and kidneys, 
ancemia, predisposition to gout. Occasionally a blue line exists 
at the junction of the teeth and gums. 

THERAPEUTIC APPLICATION.— Lead is used almost ex- 
clusively in the form of a solution of the acetate as an astringent 
and hcemostatic over abraded surfaces and inflamed mucous mem- 
branes, as those of the urethra and vagina, etc., and also for itching 
skin affections. 

Formerly it was employed more than at present internally to 
check diarrhoea. Its use in the past for hemorrhage in remote 
parts as the lungs and kidneys was obviously irrational. 

It should not be given over a prolonged period of time, either 
as injections or internally, for fear of chronic poisoning. 

MATERIA MEDICA. 

Plumbum Oxidum (U.S. P., B.P.), or litharge; yellowish-red powder* 
insoluble in water, soluble in nitric and acetic acid. Used for making the 
plaster of lead and the lead acetate. 

Emplastrum Plumbi (U.S.P., B.P.), or diachylon plaster. 

Plumbi Acetas (U.S. P., B.P.), or sugar of lead, colorless, heavy crystals 
with a faintly acetous odor and a sweetish astringent taste. Efflorescent 



254 INORGANIC DRUGS. 

and absorbs carbon dioxide on exposure to the air. Soluble in 1.8 parts 
of water. Dose: — 0.05 to 0.1 G. Br. (1-5 grains). Average (U.S.P.), 
0.065 G. 

Liquor Plumbi Subacetatis (U.S.P.), or Goulard's extract, contains 25 
per cent, lead subacetate in watery solution. 

Liquor Plumbi Subacetatis Dilutus (U.S.P., B.P.), contains 3 per cent, 
of the above. 

Ceratum Plumbi Subacetatis (U.S.P.), contains 20 per cent, of Gou- 
lard's extract, with 2 per cent, camphor. 

Plumbi Iodidum (U.S.P.), bright yellow powder, without odor or taste, 
only soluble in about 2,000 parts of water. 

Unguentum Plumbi Iodidi (U.S.P., B.P.), contains 10 per cent, lead 
iodide. 

GROUP OF MERCURY. 

MERCURY, or quicksilver, forms albuminous compounds sol- 
uble in salt solution or in an excess of albumen such as is present 
in body fluids. It is the most easily absorbed metal and, there- 
fore, gives rise to definite constitutional symptoms which last 
over a prolonged period of time because of its slow excretion. 

On account of its affinity for albumins and of its deleterious 
effect on living protoplasm mercury is an irritant and antiseptic. 
Its action varies greatly on different germs but it is one of the 
most active of the antibacterial metals. Since the time of Para- 
celsus, it was known that mercury frequently influenced the dis- 
ease syphilis, but it was only of very recent date that a specific 
action against syphilis has been proved by Metchnikoff. He 
found that if a subject is inoculated with the virus containing the 
spirochaeta pallida and the site of inoculation is treated with an 
ointment of calomel within twenty minutes, no infection occurs. 
Yet it has very little action on the unorganized ferments such as 
pepsin and pancreatin, and unless the concentration is sufficient 
to precipitate the ferments it does not alter the digestion. Calo- 
mel, an insoluble salt of mercury, does not check digestion even 
in large doses, but hinders markedly putrefactive decomposition 
in the intestines; thus the stools are frequently green after this 
drug, due to the fresh pigment preserved from destruction by 
the sterilization of the alimentary canal. 

Since mercury forms soluble compounds with proteids it pene- 
trates deeply into living tissue and therefore acts rather as a caus- 



GROUP OF MERCURY. 255 

tic than as an astringent. With the salts of this metal as with 
those of others the local action is partly dependent on the acid 
ions and varies in intensity with the caustic power of the acid con- 
stituent and its ease of dissociation. When any salt of mer- 
cury is injected subcutaneously or intramuscularly there is always 
a great deal of pain and inflammatory reaction. 

Mercury in all its different forms, as soluble and insoluble com- 
pounds, and even in the metallic state, is absorbed by living or- 
ganisms. It may enter the system by all channels, gastrointes- 
tinal tract, epidermis, subcutaneous and muscular tissues and 
lungs. Both soluble and insoluble inorganic compounds are in 
part or wholly transformed to albuminates before absorption. 
Thus even the metallic form rubbed into the skin in a fine state of 
subdivision mixed with fat is absorbed partly as an albuminate 
and partly in combination with fatty acids. When the element is 
taken internally in a finely divided condition it is probably dis- 
solved by acids in the gastro-intestinal tract and passes into the 
circulation combined with proteids. That which is absorbed as 
fumes by the lungs or the skin probably also becomes trans- 
formed to albuminates during its absorption. 

When strong solutions of mercurial compounds are given by the 
mouth, acute poisoning follows with the symptoms of gastro- 
enteritis, as burning in the mouth, throat, oesophagus, violent 
griping pains in the abdomen, nausea, vomiting and diarrhoea 
(both the latter may be bloody with shreds of mucous membrane) , 
anuria, cold clammy skin, small irregular pulse, decreased respira- 
tion and collapse. The acute form of poisoning has in a few 
instances followed absorption from wounds or from the vagina 
after too concentrated corrosive sublimate douches. Last year, 
several cases were reported of acute constitutional poisoning fol- 
lowed by death after the introduction of solid corrosive sublimate 
tablets into the vagina by ignorant women with the object of 
producing abortion. Poisoning from local application is prac- 
tically identical with the internal except that the corrosion of 
the mouth is less marked at first. Chronic symptoms may fol- 
low if the subject survives. 

Occasionally, chronic poisoning results from one or two doses 



256 INORGANIC DRUGS. 

which are insufficient to produce acute symptoms. But, as a 
rule, it occurs when small doses are administered by any chan- 
nel of absorption over a long period of time. The chronic 
symptoms of poisoning are seen principally in the gastrointes- 
tinal tract where mercury is in part excreted. Also passing out 
of the body by the saliva it produces irritation of the whole 
mouth, resulting in swelling of the salivary glands, great saliva- 
tion, fetid breath, swelling of the tongue and gums, even with 
ulceration and necrosis of the latter which may extend to the jaw, 
and dropping out of the teeth. 

Some is excreted by the gastric juice, but in much larger 
quantities by the intestines and especially the large ones where 
it produces its most marked action. Iri small doses it may pro- 
duce simple hyperemia of the gastro-intestinal tract and increased 
intestinal peristalsis attended with loose movements. In larger 
doses, it causes well marked inflammation and even ulceration 
and sloughing, most marked in the large intestines. Since it is 
excreted also by the kidneys, it occasions severe inflammation 
and degeneration of these organs and, in a characteristic way, the 
necrotic, degenerated cells of the tubules become rilled with de- 
posits of calcium phosphate. Mercury is also found in the 
perspiration and this may account for the skin eruptions some- 
times observed after prolonged administration. Besides these 
symptoms of irritation of the excretory channels there are others 
referable to the central and peripheral nervous systems. 

On account of its action on the central nervous system, it 
produces a state of great nervous irritability, timidity, hallucina- 
tions, sometimes delirium, attended by sleeplessness, headaches 
and tremors (mercurial erythism). It causes a peripheral 
neuritis, especially affecting the myelin sheath of the nerves and 
thus occasioning sharp pains in the extremities and various paral- 
yses, but the muscles remain undegenerated with intact electrical 
reaction. This forms a striking difference from the lead and 
arsenic neuritis. 

At first the metabolism is beneficially changed, the subject 
gains weight and the haemoglobin of the blood is increased, 



GROUP OF MERCURY. 257 

probably through hyperemia of the bone marrow. Later the 
opposite symptoms occur, loss of weight, anaemia, cachexia and 
death in general marasmus. The improvement in body weight 
and in the blood is especially well seen in syphilitic subjects. 
The urine may also contain sugar, besides albumin and casts. 
In mercurial poisoning occasionally the different parenchymatous 
organs show evidence of fatty degeneration yet the normal fat in 
the tissues and bone marrow soon disappears. 

Given intravenously in large doses in the form of a compound 
soluble in the fluids of the body, mercury produces intense irrita- 
tion of the kidneys. The secretion of these organs, after a very 
temporary increase, is diminished in quantity, and there appear 
albumen, casts and blood and lastly total suppression. The 
blood pressure sinks from paralysis of the vasomotors and heart 
and death ensues. Formerly mercurial preparations were said to 
stimulate the flow of bile, but direct experiments have never 
shown any such effects even though they are in part excreted by 
the liver. 

The excretion of mercury which is very slow takes place chiefly 
in the urine, saliva, gastric and intestinal secretions and in traces 
in the bile, perspiration, milk and also from the placental circula- 
tion into the foetus in pregnant women. 

SUMMARY OF GROUP ACTION.— Strong antiseptic action, 
also irritant and caustic. Symptoms of acute poisoning are those of 
gastro-enteritis and nephritis. In chronic poisoning besides the gas- 
trointestinal tract and kidneys, the skin, central nervous system, 
peripheral nerves, blood and general metabolism affected. Elimi- 
nated chiefly by intestines and kidneys. 

THERAPEUTIC APPLICATION.— The chief employment of 
mercury in medicine is in the treatment of syphilis. Its bene- 
ficial action, which in some cases is quite wonderful, is probably 
due both to its influence on metabolism and to a specific effect on 
the Treponema pallida, the causal agent of the disease. The fact 
that many cases of syphilis are cured of the primary and secondary 
symptoms simply by improving their metabolism through hy- 
gienic means and other measures without mercury leads us to 
17 



258 INORGANIC DRUGS. 

infer that at least some of the action of mercury may be due to its 
influence on nutrition; but on the other hand, the occurrence of 
cases where all hygienic measures and other means used to alter 
the metabolism have failed, but where the use of mercury brings 
about immediate improvement, lead us to believe that mercury 
acts at least to some extent by influencing the specific cause of 
syphilis. It is used in the treatment of this disease in almost all 
its forms and by all methods of administration, internally, sub- 
cutaneously, by inunction, by fumigation, inhalation, intra- 
venously, etc. 

On account of their deleterious influence upon living proto- 
plasm, preparations of mercury are used as antiseptics internally 
and externally. Corrosive sublimate is the most commonly em- 
ployed as a surgical antiseptic to wash wounds. Calomel has 
the preference as an intestinal antiseptic. Almost all forms of 
mercury are employed in the form of ointments as disinfectants 
and irritants in various skin diseases. For pediculi pubis, blue 
ointment is especially used. Calomel is frequently dusted on 
syphilitic chancres. 

Mercurials, especially calomel, are given as purgatives on 
account of the stimulant action on the intestines. The latter 
was formerly used as a cholagogue, but it is now known not to 
increase the flow of bile. 

Calomel has been used with success as a diuretic in some cases 
of dropsy, of cardiac and hepatic origin. The action is probably 
due partly to the stimulant effect on the renal epithelium, and pos- 
sibly partly to some action on serous membranes causing the 
absorption of fluids. It has been observed to produce diuresis in 
some cases of renal dropsy, but if used at all in these cases it 
must be given with extreme caution on account of its local effects 
on the kidneys. 

MATERIA MEDICA. 

Hydrargyrum cum Creta (U.S. P., B.P.), or grey powder, contains 38 
per cent, of metallic mercury besides prepared chalk, honey and water. 
Dose : — 0.05 to 0.5 G. Br. (2-8 grains). Average (U.S. P.), 0.25 G. 

Massa Hydrargyri (U.S. P.), or blue mass. It contains 33 per cent, of 



GROUP OF MERCURY. 259 

mercury, besides honey of rose, licorice, althaea and glycerine. Dose: — 
0.05 to 0.5 G. Average (U.S.P.), 0.25 G. 

Unguentum Hydrargyri (U.S.P., B.P.), or blue butter, contains 50 per 
cent, of mercury. Dose: — 1.0 to 5.0 G. by inunction. Br. 0^-i 5). 

Unguentum Hydrargyri Diluti (U.S. P.), 33 per cent. 

Emplastrum Hydrargyri (U.S. P., B.P.), contains 30 per cent, mercury. 

Emplastrum Ammoniaci cum Hydrargyro (B.P.), contains 18 per 
cent, mercury. 

Hydrargyri Oxidum Rubrum (U.S. P., B.P.), or red precipitate, orange 
red crystalline scales almost insoluble in water. 

Unguentum Hydrargyri Oxidi Rubri (U.S.P., B.P.), contains 10 per 
cent, red mercuric oxide. 

Hydrargyri Oxidum Flavum (U.S.P., B.P.), yellow mercuric oxide. 
Light orange yellow, amorphous heavy powder. 

Unguentum Hydrargyri Oxidi Flavi (U.S. P., B. P.), contains 10 per 
cent, yellow oxide in U.S. P. and 2 per cent, in B.P. 

Oleatum Hydrargyri (U.S. P.), Hydrargyri Oleas (B.P.), contains 20 
per cent, of yellow oxide. 

Hydrargyri Chloridum Corrosivum (U.S. P.), Hydrargyri Perchlori- 
dum (B.P.), corrosive sublimate, white crystalline body with a caustic acrid, 
metallic taste, soluble in 16 parts of water, 3 parts of alcohol. Dose: — 
0.001 to 0.005 G. Br. (A— 3 grain). Average (U.S. P.), 0.003 G. 

Hydrargyri Chloridum Mite (U.S. P.), Hydrargyri Subchloridum 
(B.P.), or calomel. A white powder without odor or taste, insoluble in 
water. Dose : — 0.03 to 0.3 G. up to 1.5 G. in 24 hours. Br. {}4-$ grains). 
Average (U.S.P.), 0.125 G. 

Lotio Hydrargyri Nigra (B.P.) or black wash, made from calomel and 
lime water. Used as a wash for syphilitic lesions. 

Lotio Hydrargyri Flava (B.P.) or yellow wash, made from lime water 
and corrosive sublimate. Used as a wash for syphilitic ulcers. 

Pilulae Catharticae Compositae (U.S. P.), contains 0.06 of calomel, be- 
sides compound extract of colocynth, extract of jalap and gamboge. Dose : 
— 1 to 3 pills. 

Hydrargyrum Iodidum Rubrum (U.S. P., B.P.) or red iodide of 
mercury. Scarlet red amorphous powder, almost insoluble in water but 
freely soluble in solutions of potassium iodide. Dose : — 0.001 to 0.005 G. 
Br. (3V-T6 grain). Average (U.S. P.), 0.003 G. 

Hydrargyrum Iodidum Flavum (U.S. P.), or yellow iodide of mercury, 
or protoiodide of mercury. It is a bright yellow, amorphous powder, odor- 
less and tasteless. Almost insoluble in water, insoluble in alcohol and ether. 
Dose : — 0.001 to 0.005 G. Average (U.S. P.), 0.01 G. 

Unguentum Hydrargyri Nitratis (U.S. P., B.P.), or citrine ointment. 
It contains 7 per cent, mercury, besides free nitric acid and lard. 

Hydrargyrum Ammoniatum (U.S. P., B.P.), white precipitate or 
ammoniated mercury. A white amorphous powder, having an earthy 
metallic taste. Almost insoluble in water, insoluble in alcohol. 

Unguentum Hydrargyri Ammoniati (U.S.P., B.P.), contains 10 per 
cent, ammoniated mercury. 



260 INORGANIC DRUGS. 

GROUP OF SILVER AND GOLD. 

SILVER has a very strong affinity for albumen and precipitates 
a dense, white, insoluble albuminate which becomes gradually 
black by the reduction of the metal. This affinity is so powerful 
that in the form of easily dissociable salts as the nitrate in con- 
centrated solutions, it acts as a strong but superficial caustic. 
In dilute solutions it is an astringent, hemostatic and antiseptic. 

After internal administration, it is so slowly absorbed that 
the larger portion passes out by the faeces. The small amount 
which enters the circulation becomes very readily deposited in 
different organs either in the form of the metal or as an organic 
compound, but it is never present in the circulation in sufficient 
quantities to induce acute constitutional poisoning. 

When large doses, however, are given internally, the symp- 
toms are those of acute gastro-enteritis, as vomiting, defe- 
cation, pain in the mouth, oesophagus, stomach and abdomen, 
pinched face, thready pulse, collapse and death. After death, 
the mucous membrane of the alimentary canal is found inflamed 
and corroded, but colored dark brown or black due to reduction 
of the silver salt. 

When small doses are given over a long period of time to human 
beings, no other symptoms are observed except those of argyria. 
These consist of a greyish-black coloration of the skin, due to 
a deposit of the silver in the corium. These deposits are also 
found in the gastro-intestinal tract, liver, kidneys, spleen, mesen- 
teric lymph glands, serous membranes, gums and vessel walls. 
The gums at the junction of the teeth are among the first places 
for the deposit and show a bluish line as in lead poisoning. 
Throughout all organs, it is the connective tissue rather than 
the epithelial cells that the pigment selects, for in the skin of man 
none is found in the epidermis. These symptoms occur when 
a sum total of at least 15 G. of silver has been administered 
to a human being in repeated doses. Since it is probably not 
excreted, that administered years before counts towards form- 
ing the condition which is incurable. Most cases of argyria 



GROUP OF SILVER AND GOLD. 26 1 

have resulted from the internal administration of silver prepara- 
tions in the treatment of nervous diseases as epilepsy and different 
cord paralyses, but some also occur from the long continued local 
application to the eye, nose, throat and vagina, also in workmen 
using silver as a pigment, as those in artificial pearl factories. 
Besides the general variety, there is sometimes a local form of 
argyria resulting from prolonged use on the skin or mucous 
membranes these, at the site of application, becoming perma- 
nently stained black. 

When double salts of silver are injected intravenously or 
subcutaneously, the main action is at first a stimulation of the 
medulla, causing a rise of blood pressure, then a paralysis of the 
central nervous system, especially of the medulla and lower 
part of the cord. The animal injected shows in the beginning a 
rise of blood pressure succeeded by a fall and arrest of respira- 
tion. If the dose has not been so large it exhibits paralysis of 
the hind limbs and if it survives for a few days, profuse bronchial 
secretion is also observed. Death takes place from failure of 
respiration. 

There is an insignificant excretion of silver by the gastro- 
intestinal tract, but none by the kidneys. No symptoms of renal 
irritation ever arise when silver is given internally to man or lower 
animals for very long periods of time. 

GOLD also forms a compound with albumin which is violet 
and easily soluble in an excess of albumen; therefore it acts as a 
more powerful and deeper caustic than silver. 

Given either subcutaneously or by the mouth, it produces 
nausea, vomiting, diarrhoea and pain along the intestinal tract. 
Ulcers are often found in the stomach and intestines. The 
kidneys are much irritated. With sufficient quantity, gold kills 
by paralysis of the central nervous system. 

PLATINUM has an action closely resembling that of gold, but 
more powerful. 

OSMIUM in the form of osmic acid is reduced by the tissues 
like silver and gold and causes a deposit of black pigment. 
When absorbed in sufficient quantities, it may cause irritation 
of the kidneys. 



262 INORGANIC DRUGS. 

SUMMARY OF ACTION OF SILVER.— Local astringent, anti- 
septic and superficial caustic. Internally absorbed very slowly and 
with small doses over a long period of time causes no other symp- 
toms except " argyria," a deposit of the metal or one of its organic 
compounds in the connective tissue of different organs. With large 
internal doses symptoms of gastro-enteritis . Injected subcutane- 
ously or intravenously as a double salt, first stimulation, followed by 
paralysis of the central nervous system. 

THERAPEUTIC APPLICATION.— Silver nitrate is used in 
the solid form or in concentrated solutions as a caustic to burn off 
warts, exuberant granulations and to clean badly healing ulcers. 
It is employed in dilute solutions as an astringent and antiseptic 
over the mucous membranes of the eye, nose, throat, vagina, 
urethra, rectum and colon in gonorrheal ophthalmia, urethritis and 
vaginitis in ulcerative colitis and prostatitis, also as a preventive 
to eye inflammation in the newborn (Crede's method). It is 
sometimes used internally for ulcers of the stomach and intestines. 

Organic preparations of silver as protargol, argyrol, itrol, 
and argonin have of late been used considerably as antiseptics 
instead of the nitrate. They are much less irritant, but also 
much less astringent and antiseptic. 

Gold and platinum have been used in the treatment of syph- 
ilis, alcoholism, hysteria and epilepsy, but without any rational 
foundation, and also without good results. 

MATERIA MEDICA. 

Argenti Nitras (U.S. P., B.P.), colorless, transparent crystals, becoming 
greyish on exposure to the light or in the presence of organic material. It 
has a bitter, caustic, strongly metallic taste, soluble in 0.6 of a part of water, 
and in 26 parts of alcohol. Used as injection in the urethra in a to to }4 per 
cent, solution. Applied to the eyes of the newborn in 2 per cent, solution, 
and in the colon in not more than to per cent. Dose: — Br. (k-}4 grain). 
Average (U.S.P.), 0.01 G. 

Argenti Nitras Fusus (U.S. P.), or lunar caustic, consists of fused silver 
nitrate and silver chloride. Used as a caustic. 

Argenti Nitras Dilutus (U.S. P.), Argenti Nitras Mitigatus (B.P.), or 
mitigated caustic, consists of sticks containing 30 per cent, silver nitrate and 
60 per cent, potassium nitrate. Also used as caustic. 

The following organic preparations of silver are often used as substitutes 
for silver nitrate because they are less irritating. 



GROUP OF IRON. 263 

Argentamine, solution of silver phosphate and ethylendiamine. 

Argonin, compound of silver and casein. 

Actol, lactate of silver. 

Itrol, citrate of silver. 

Argyrol, Largin and Protargol, all albuminates of silver. 

All these are used in the same way of silver nitrate, but in considerably 
greater strength. 

Auri et Sodii Chloridum (U.S. P.), yellow, deliquescent crystals, very 
soluble in water, with a metallic burning taste. Dose : — 0.001 to 0.005 G. 



GROUP OF IRON. 

IRON is one of the most important constituents of living organ- 
isms and its presence is even more diffused than that of "salt," 
for it is found in the tissues of all animals and plants. In the 
former, the larger part is combined with haemoglobin in the red 
blood corpuscles, yet quite a significant portion is present in the 
liver in the form of an acid albuminate. Every tissue, even the 
bloodless cornea, contains iron. In the plants this important 
metal plays often as important a role as in animals. At other 
times, plants may live without it, but have no chloropyl and their 
development is stunted. 

Iron forms insoluble precipitates with albumins and, therefore, 
acts as an astringent. In strong solutions, it is an irritant 
and then a caustic on account of its affinity for the albumin 
of the living cells; for the same reason it is an antiseptic. The 
precipitate with proteids being insoluble, its effect is only super- 
ficial and not deeply penetrating like that of mercury. It also 
hastens the coagulation of blood and tends to arrest hemor- 
rhage. The local action of iron is best seen with the inorganic 
forms as the organic have little or no direct effect. 

Given in large quantities by the mouth in the form of one of 
its soluble inorganic salts, iron produces simply local corrosive 
poisoning exactly like the majority of other metals, with symp- 
toms of pain in the stomach, nausea, vomiting, purging, both of 
which may be bloody, small pulse and even fatal collapse. 

Injected into the circulation in the form of easily dissociable 
double salts, it causes its ion-action which consists of gastro- 
intestinal irritation, nausea, vomiting and diarrhoea which may 



264 INORGANIC DRUGS. 

be bloody, congestion and even hemorrhage in the intestines, 
also great fall of blood pressure, paralysis of the central nervous 
system and death which takes place after 0.06 G. per kilo of 
body weight. The heart is not much weakened. In acute 
poisoning the kidneys are almost unaffected because the drug is 
excreted only in small quantities (about 2-3 per cent.) by these 
organs; but when small doses are given subcutaneously over a 
long period of time marked renal inflammation appears. The 
gastro-intestinal symptoms are due to the almost exclusive ex- 
cretion of iron by this channel. 

Administered by the mouth in small quantities over a period 
of time, iron is absorbed mainly by the duodenum and jejunum. 
It is carried to the spleen and liver and is temporarily stored 
as hepatic ferratin (iron albuminate) in the latter organ. It is 
there utilized to supply more iron to red corpuscles, and ulti- 
mately excreted by the intestines, especially the ccecum and 
large intestines. The quantity of iron normally excreted by the 
urine is not noticeably increased by its internal administration, 
and therefore when taken internally has no influence on the 
kidneys. The former view, that it acts as a diuretic, may be 
discarded. The quantity absorbed from the intestinal tract is much 
greater when there is a deficiency of iron in the system. Both the 
organic and inorganic salts of iron are absorbed and undergo 
the same fate, yet the former enter the circulation more easily 
and this is especially true of ferratin. The inorganic are prob- 
ably transformed to albuminates before or during their absorp- 
tion. The black stools after the administration of chalybeates 
result from the presence of the unabsorbed iron in the form of an 
oxide and sulphide. After the prolonged use of ferruginous 
preparations the teeth turn dark due to a precipitate of a sulphide 
by the sulphuretted hydrogen in the breath. 

MANGANESE is found in traces in the organism yet no very 
important role has been discovered for it. In large doses of 
soluble salts, it causes gastro-enteritis just like iron and other 
metals. It is absorbed only in minute amounts from the intes- 
tinal tract, therefore, possesses no constitutional action except 



GROUP OF IRON. 265 

after hypodermic and intravenous injections. Under these 
conditions it causes in large doses epileptiform convulsions, 
nausea, vomiting, diarrhoea, somnolence, collapse and death 
due to failure of respiration. 

NICKEL and COBALT act upon the central nervous system, 
stomach and intestines very much like iron but unlike the latter 
they have no influence upon the haemoglobin. No chronic 
poisoning is known even though a certain amount may be dis- 
solved in the food by cooking acid elements in nickel pans. 

SUMMARY OF GROUP ACTION.— Iron is essential to the life 
of animal organism and after internal administration of both or- 
ganic and inorganic preparations, it replaces the deficiency of this 
metal. Absorbed by the duodenum and jejunum. Excreted chiefly 
by the ccecum and large intestines. Very toxic ionic action when 
injected intravenously consisting of great depression of the central 
nervous system, especially well-marked fall of blood pressure due 
to vasomotor paralysis and respiratory failure. Symptoms of 
intestinal irritation also present from the excretion of iron by the 
intestines. 

THERAPEUTIC APPLICATION.— Both Iron sulphate and 
chloride, are used in solution locally as astringent and antiseptic 
washes or as injections to inflamed mucous membranes as those of 
the urethra and vagina. They are also employed as styptics to 
stop hemorrhage of wounds of the skin and of the mucous mem- 
branes of the nose, mouth, vagina, uterus, etc. 

The chief use of iron is to increase the haemoglobin in anemic 
conditions. Its most favorable field is in chlorosis and in this 
affection sometimes marvelous results are observed. One great 
drawback in the administration of iron internally is the constipa- 
tion which it produces, because of its astringent action. This, 
however, can be overcome by the use of laxatives, or by employ- 
ing the organic preparations which have but little astringent 
action. 

MATERIA MEDICA. 

Ferri Sulphas (U.S.P., B.P.), green vitriol, bluish-green crystals, soluble 
in 1.8 parts of water, insoluble in alcohol. Dose: — 0.03 to 0.3 G. Br. 
(1-5 grains). Average (U.S. P.), 0.2 G. 



266 INORGANIC DRUGS. 

Pilulae Ferri Carbonatis (U.S.P.), Pilulae Ferri (B.P.), or Blaud's Pills, 
containing 0.16 of ferrous sulphate. Dose : — 1 or 2 pills. 

Ferri Chloridum (U.S. P.), orange yellow, deliquescent crystalline pieces, 
having a faint odor of hydrochloric acid. Soluble in water, alcohol and 
ether. 

Liquor Ferri Chloridi (U.S. P.) contains 38 per cent, of ferric chloride. 
Dose: — 0.1 to 0.5 c.c. Average (U.S.P.), 0.1 c.c. 

Tinctura Ferri Chloridi (U.S.P.) contains 25 per cent, of liquor ferri 
chloridi. Dose: — 0.5 to 2.0 c.c. Average (U.S.P.), 0.5 c.c. 

Tinctura Ferri Perchloridi (B.P.). Dose: — (5-15 tir)- 

Ferri Citras (U.S.P.) , thin, transparent, garnet-red scales, odorless, 
having an acid reaction. Very soluble in water, insoluble in alcohol. 
Dose:— 0.1 to 0.5 G. Average (U.S.P.), 0.25 G. 

Triferrinum is a ferric nucleate containing 22% of iron, 0% nitrogen 
and 2.5% phosphorus in organic combination. It is composed of a brownish, 
tasteless powder soluble in weak alkalies but not in weak HC1. It is by 
far the best of the organic preparations of iron on the market and contains 
one of the highest percentages of iron. Dose : — 0.3-0.5 G. 

Ferratin, a chocolate brown powder, composed of an albuminate of iron, 
insoluble in water, but slightly soluble in alcohol. It contains 6% iron. 
Dose: — 0.5 to 1.0 G. 

Ferri Oxidum Hydratum cum Magnesia (U.S.P.), or the antidote 
of arsenic, kept in two separate bottles; in one the hydrate of iron, in the 
other the magnesia, to be mixed before using. Dose : — Ad libitum. 

There are on the market a considerable number of practically worthless 
organic iron preparations which contain from a fraction to a little over one 
per cent, iron, and in the doses recommended, their effect would be no 
greater than that of some of the ordinary food stuffs. 



GROUP OF ARSENIC AND ANTIMONY. 

ARSENIC has been of tremendous toxicological interest since 
the sixteenth century. It was used at that time in the form of 
the celebrated Aqua To f ana for homicidal purposes, and until the 
present, it has been the most celebrated poison in cases of suicide, 
homicide and accidental poisoning. Nevertheless, it was re- 
cently found to be normally present in minute traces in many liv- 
ing organisms including man. Certain of its actions resemble 
those of phosphorus with which it is chemically classed, yet there 
is a striking difference in the two, as phosphorus acts in the organ- 
ism as the element, while arsenic exerts its effects by the dis- 
sociated ions of arsenious oxide, and those preparations which 
cannot be ionized into arsenious oxide do not have the character- 
istic action; thus arsenuretted hydrogen which cannot be oxidized 
in the system has an entirely different effect. The arsenic oxide 



GROUP OF ARSENIC AND ANTIMONY. 267 

and its salts are much weaker but cause the same changes because 
they are probably transformed in the body to arsenites. 

Cacodylates, organic compounds of arsenic, which are de- 
composed with difficulty, have at first an entirely different action, 
but later, as they become slowly transformed, they show in a 
lesser degree the characteristic poisoning. 

When ARSENIOUS ACID is applied to the skin for a consid- 
erable length of time, it produces redness, vesicles and pustules, 
and if the tissue be denuded or if it be applied to a mucous 
membrane, it penetrates deeply and produces deep-seated necro- 
sis. This action is not due to a coagulation of the albumen, as 
it forms no albuminous compounds outside of the body. But 
it is the result of a selective action on living protoplasm which 
arsenic possesses in a more marked degree than any other of the 
metals. By virtue of this property it is an irritant and caustic. 

It has also a certain amount of antiseptic action, but much 
less marked than mercury. Even in great dilution it stops the 
growth of many higher plants and algae. It possesses but slight 
action on the fungi and does not interfere with the activity of 
unorganized ferments, as pepsin, pancreatin, myrosin and 
emulsin. 

Given by the mouth or injected subcutaneously, a large dose 
of arsenic produces in a short time symptoms of poisoning 
which consist of a burning sensation in the oesophagus, stomach 
and intestines, violent griping pain, vomiting, diarrhceic move- 
ments which may resemble the "rice water stools'' of cholera, 
and may contain blood, flakes and pseudomembranes. The 
skin is blanched, the respiration weak and superficial, the pulse 
almost imperceptible. Great weakness develops and the patient 
becomes comatose; sometimes delirium and convulsions occur 
and he dies in from about live to twenty hours. When large 
doses are readily absorbed, the gastro-intestinal symptoms may 
be entirely omitted and collapse with coma and death may take 
place at the very beginning. 

If less arsenic is taken or if the absorption is slow, the gastro- 
intestinal symptoms are very marked and after great vomiting, 



268 INORGANIC DRUGS. 

diarrhoea and excruciating pain in the abdomen, death occurs 
in a few days or a week's time. In such cases skin eruptions, 
jaundice and enlargement of the liver may be present. The 
urine is scanty and contains albumin, casts, much ammonia and 
lactic acid, and the urea is diminished. 

Following one large dose, if the subject lives long enough, or 
more commonly following the ingestion of repeated small quan- 
tities, a series of chronic symptoms arise. These consist of 
loss of appetite, nausea, vomiting, sometimes diarrhoea, discom- 
fort and tenderness in the stomach and bowels and enlarge- 
ment of the liver, inflammation of the respiratory passages and 
eyes, giving rise to bronchitis, laryngitis, coryza and conjunc- 
tivitis, disturbances of the skin resulting in eruptions and pig- 
mentations and oedema, especially pumness about the eyes, 
inflammation of the peripheral, sensory and motor nerves re- 
sulting in numbness, perverted sensations, shooting pains, 
paralysis of limbs, especially of the extensor functions, with 
ataxic gait, atrophy of muscles, psychical depression, sometimes 
idiotic condition and epilepsy, general cachexia with albuminuria, 
emaciation and sometimes death. 

In acute arsenical poisoning, death takes place on account of the 
paralysis of the blood vessels of the splanchnic area which 
results in intense congestion of the intestinal organs and in a 
serious or fatal fall of blood pressure. The action is quite specific 
on the intestinal distribution of blood vessels, for those in other 
parts of the body do not suffer in the same degree. The effect 
is produced at first through the vasomotor centre and the splanch- 
nic ganglia, but later the walls of the vessels themselves are af- 
fected. Not only is there a tremendous dilatation of the latter, 
but their permeability is increased so that they allow more easily 
the passage of fluids, and this fact explains the copious rice-water 
discharges. The increase in permeability in other vessels prob- 
ably accounts for the oedema noticed in chronic arsenic poisoning. 

The nervous symptoms of depression, the interference with 
respiration and the gastro-intestinal disturbances can all be 
explained by this intestinal congestion, attended by a great fall 



GROUP OF ARSENIC AND ANTIMONY. 269 

of blood pressure. In warm-blooded animals, the nervous sys- 
tem is practically unaffected because death takes place too soon 
from fall of blood pressure. In frogs, descending paralysis 
occurs and the heart is weakened and stopped in diastole. The 
depression of the cardiac muscle is present, but is not so obvious 
in warm-blooded animals. 

In the doses required to produce fatal acute poisoning, outside 
of the softening of the superficial layer of the epithelium, no real 
corrosion of the intestinal tract is seen, but only great congestion 
and even hemorrhages and also cloudy swelling and fatty de- 
generation of the cells. This fatty degeneration is best seen in 
chronic arsenic poisoning and involves besides the intestines, the 
heart, kidneys, liver, spleen and glands. It is probably the re- 
sult of decreased oxidation, as is likewise the diminution of urea 
with the increase of ammonia and lactic acid in the urine. 

When very minute doses of arsenic are given over a long period 
of time an increase in weight, in adipose tissue, in red blood 
corpuscles and haemoglobin occurs. The augmented weight is 
probably due to the decreased burning up of food material which 
is more rapidly absorbed on account of a mild congestion of the 
intestines. The increase in the red corpuscles is probably due 
partly to the improvement of nutrition and partly to congestion 
and stimulation of the bone marrow. Not only the bone mar- 
row may be stimulated, but the entire bone may grow larger and 
stronger. 

As was previously mentioned, if doses eliciting poisonous symp- 
toms are administered, the reverse effect takes place, i. e., decrease 
in body weight and in red blood corpuscles and haemoglobin. 

In the Tyrol and Syria the peasants take arsenic in large 
doses regularly without any apparent ill effects. They claim 
that it improves their general health and they undoubtedly 
live to old age. This is possibly explained by the fact that ar- 
senic, being a normal constituent of the body, by gradually 
increasing the dose they gain high tolerance. The fact that 
arsenic miners in some other districts become badly poisoned, 
is apparently quite inconsistent. Yet they undoubtedly are 



270 INORGANIC DRUGS. 

exposed to too large doses from the beginning so that before 
immunity occurs, they fall prey to the poisoning which is in- 
tensified by the bad hygienic surroundings attended by working 
in mines. An ingenious explanation for tolerance has lately 
been adduced by Cloetta. He believes that the intestinal mucosa 
gradually loses the power of absorbing arsenic after repeated 
small doses and that in this fact lies the explanation of the ability 
of arsenic eaters to take several times the fatal dose. 

Symptoms of chronic poisoning may arise from the use of 
arsenic locally as a caustic, when too large doses are given in 
therapeutics, or from its accidental presence in food stuffs, cloth- 
ing or wall paper. Whether symptoms are elicited or not, de- 
pends enormously upon the individual susceptibility. Of several 
persons exposed to the same amount of arsenic, usually only a 
certain percentage are affected while the other are not. Usually 
the train of symptoms differs in different cases, for instance indi- 
viduals suffering from medicinal overdose usually show at first 
dyspepsia, pufhness of the lids and irritation of the eyes and 
nose and albuminuria ; those poisoned from clothing frequently ex- 
hibit at the beginning skin eruptions, while workmen with arsenic 
in factories or mines are apt to suffer in the beginning from severe 
respiratory inflammation besides skin eruptions. 

Arsenic is excreted mainly by the kidneys, but in small part 
by the skin, respiratory tract and bowel. It is found in the 
milk of nursing women. It is probable that the symptoms of 
irritation seen in the excretory organs in chronic poisoning are 
due to its passage through them. 

The temperature may be elevated in arsenical poisoning 
from the inflammation of the intestinal tract, but when the symp- 
toms of collapse are present it is usually subnormal. 

ORGANIC ARSENIC PREPARATIONS. 

For many years sodium cacodylate has been used in medicine to 
a small extent as a substitute for the simpler arsenic compounds, 
because it is much less toxic than the latter. The reason for this 



GROUP OF ARSENIC AND ANTIMONY. 27 1 

lesser toxicity is due to the fact that cacodylates are only very 
slowly decomposed in the body with the formation of free arsenic. 
The amount of free arsenic liberated being so minute, it was found 
that cacodylates possessed very little arsenic action and were 
used less and less. 

Ehrlich's work with the triphenyl-methane and benzidin dyes, 
and with a large group of synthetic arsenic compounds with the 
object of rinding antiseptic agents which would kill pathological 
micro-organisms in the body and blood of animals and human 
beings, without proving toxic to the host, has given new interest 
in organic arsenical compounds. 

One of the earliest of these substances which did prove success- 
ful in sterilizing the blood of some animals from trypanosomes 
was atoxyl or sodium arsenylate. At first great hopes were mani- 
fested in this substance, because it was much less toxic than 
arsenic and did have in some cases this marked sterilizing effect. 
It was recommended and used in trypanosomatous diseases, as 
dourine, tsetse, mal de caderas, etc. It was also used in syphilis. 
The action seemed to be due either to the molecule of the whole or 
to some partial decomposition product, but not to simple arsenic. 
The results, which seemed brilliant in a few cases, were very dis- 
appointing in others. The explanation of this soon appeared, 
when it was found that the micro-organisms themselves easily 
acquired an immunity towards the drug when repeated doses 
were given. Except in a few conditions in experimental animals, 
it was found impossible to give a single dose sufficiently large to 
produce the desired effect without harming the host. Further, 
it was soon discovered that atoxyl, though less acutely toxic, 
possessed far more frequent and severe untoward effects than 
arsenic itself. Among these symptoms were dizziness, headache, 
fever, gastro -intestinal disturbances, as nausea, vomiting, diar- 
rhoea and colic, nephritis and paralysis of nerves, giving rise to 
permanent paralysis of limbs, of the sphincters of the rectum and 
bladder, and of the optic nerve, resulting in partial or complete 
blindness. Experimental works upon animals have shown, after 
small doses, destructive processes in the optic nerve and retina 



272 INORGANIC DRUGS. 

and in the cord. These effects are probably produced, not by 
the ionized arsenic, but by the compound as a whole. 

With the hope of overcoming all these untoward symptoms and 
also of obtaining a much more active drug, Ehrlich made the 
acetyl derivative which he called arsacetin. This compound had 
a history almost similar to the preceding, so that its use was soon 
dropped as a complete sterilizing agent in the blood. Neverthe- 
less, it and others of these compounds were found to have far 
greater antiseptic action if combined with other substances, as 
antimonial and mercury salts, than the sum-total of the action of 
each separately. For this reason atoxyl and arsacetin have been 
employed combined with mercury in the treatment of syphilis 
with some degree of success. 

Not discouraged by these two failures, Ehrlich set to work 
again, still more arduously, and after having synthetized and 
tested out 606 new arsenical compounds, he found in the one 
bearing that number, dioxydiamidoarsenobenzol, which was 
named salvarsan, properties of blood sterilization heretofore un- 
equaled in any of the preceding ones in the series. This disin- 
fectant action was particularly well marked towards the trep- 
onema pallida of syphilis. It is not highly toxic, for one gram has 
been given to man in a single dose without serious results. It has 
been calculated from the average monkey dose, that a human 
being might be given 5 to 6 grams at one injection without fatal 
results, but the actual test has not yet been made. 

At first it was claimed that a single injection was completely 
curative as far as removing the presence of all the symptoms of 
syphilis, including the Wasserman and the Noguchi reactions. 
Within a few months after the first appearance of this much- 
lauded substance, innumerable articles began to appear and still 
continue to do so, denying the curative effect of a single dose in 
either secondary or tertiary syphilis. Concerning the primary 
stage, opinions are divided, but it seems highly probable that 
many cases may be cured. 

Besides the reports denying a wonderful curative power to 
salvarsan, hordes of case-records have been published showing 



GROUP OF ARSENIC AND ANTIMONY. 273 

untoward effects and sudden death resulting from one to three 
injections of salvarsan. One of the disagreeable untoward effects 
has been the great local reaction with even gangrene and exquisite 
pain at the site of injection by the subcutaneous or intramuscular 
method. These results have led to the use of the intravenous 
method. Such symptoms as headache, vomiting and fever are 
not uncommon. Cases of hemiplegia and other paralyses fol- 
lowed the use of salvarsan. 

The type of fatal cases runs about as follows : one to two days 
after the injection, the patient experiences violent headaches, 
generalized pain in all the limbs, sometimes paralyses, nausea 
and vomiting, convulsions and death in coma. Such deaths 
have occurred in several young subjects twenty odd years old. 

The action of ARSENURETTED HYDROGEN is quite differ- 
ent. This compound is also very poisonous, producing destruc- 
tion of the red corpuscles, met hemoglobinuria, cyanosis, head- 
ache, vomiting, garlicky odor in the breath, and death due to 
paralysis of the heart and sometimes to oedema of the lungs, but 
it does not have the characteristic effects of the ions of arsenious 
oxide. 

ANTIMONIAL compounds have an action almost identical to 
that of arsenic. They differ because they are much more diffi- 
cultly absorbed and have a greater local irritant action. The 
main symptoms are intense nausea, vomiting, diarrhoea and col- 
lapse. The vomiting is so rapid and intense that most of the anti- 
mony is removed by emesis, and, therefore, fatal results are much 
less frequent than with arsenic. 

The small quantities absorbed after internal administration 
are excreted in part by the respiratory tract so that there is irrita- 
tion of these parts. This action plus the feeling of nausea tends 
to increase the bronchial secretion. Antimony is also excreted by 
the urine and feces. Chronic poisoning rarely occurs on account 
of the poor absorption. 

Like arsenic, antimony was also used to make organic com- 
pounds which might have sterilizing influence in the blood of the 
living. Among these was one analogous to atoxyl, paraamino- 
18 



274 INORGANIC DRUGS. 

phenylstibinic acid, which was found to be very active in lower 
animals affected by trypanosomiasis. It was also recommended 
and used, to a certain extent, in the treatment of sleeping sickness 
in human beings. It produces, unfortunately, marked untoward 
effects, among which is irritation of the kidneys. More recently, 
Abel and Rowntree have experimented with compounds of anti- 
mony with thiogly colic acid. They have obtained most encourag- 
ing results in experimental animals with sodium antimony thiogly- 
collate and the triamide of antimony, thioglycolic acid, and warmly 
recommend that these compounds should be tried in human beings 
for the sleeping sickness. 

SUMMARY OF GROUP ACTION.— Destructive action to life of 
cells but no influence upon dead proteid, therefore, irritant and caustic 
action different from that of all other metals. Taken internally 
in large doses, paralysis of vessels of splanchnic area which causes a 
great fall of blood pressure, choleric discharges from the bowels, 
collapse and death. The chronic poisoning is due to the irritation 
and degeneration of the central nervous system, peripheral nerves, 
skin, kidneys and gastro-intestinal tract and is accompanied by 
serious disturbances of metabolism. Very minute doses insufficient 
to produce poisonous symptoms improve the general metabolism. 

THERAPEUTIC APPLICATION.— Arsenic was used locally 
as a caustic to burn off new growths. This use has been laid aside 
on account of the occasional occurrence of poisoning from ab- 
sorption. It is applied in dentistry to kill the nerves of teeth. 

Internally it is employed for its effect on metabolism to improve 
almost all conditions of malnutrition, in ancemia to increase the 
red blood corpuscles and also in long-standing malaria. Here 
its good effects may be due either to improvement of metabolism 
and of the anaemia or to a special action against the malarial 
parasite. 

In lymphoma, where it is sometimes used with good effect, its 
action may possibly be due to the production of a retrograde 
metamorphosis in the lymph glands. 

Arsenical preparations have an important field in the treatment 
of certain skin diseases, especially psoriasis. They may produce 



GROUP OF ARSENIC AND ANTIMONY. 275 

beneficial influences in these conditions, either by improving 
the general metabolism or the special metabolism of the skin. 
The latter view is rather supported by the fact that arsenic is 
normally present in appreciable quantities in the corium. 

Salvarsan, and to a less extent, atoxyl and arsacetin are used 
in the treatment of syphilis. Salvarsan, which is much less 
poisonous and much more active has to a great extent replaced 
the other two. As has been said in describing its pharmacology, 
it does not have the absolutely marvelous curative powers which 
were attributed to it when first discovered. Nevertheless, it 
often benefits cases which are not affected by mercury, and when 
given in conjunction with the mercurial treatment, it greatly 
diminishes the length of the treatment, so that instead of waiting 
three to four years a patient may be cured in from a few months 
to a year. Salvarsan is said also to be active in relapsing fever, 
in frambesia, in yaws, in filaria and in tertian malaria. It has 
not been found active in the quartan nor in the estivo-autumnal 
malaria, nor in leprosy. 

The treatment of acute arsenical poisoning consists of the 
administration of freshly precipitated ferric hydrate or ferric 
hydrate and magnesia, which form an insoluble compound with 
arsenic. An emetic should be given at once, or the stomach 
should be washed and a cathartic administered, because this 
insoluble compound may be again decomposed if left in the 
alimentary canal. 

Chronic arsenical poisoning which comes from contaminated 
articles of food and sometimes clothes and wall-papers containing 
arsenic, is treated by removing the cause, improving hygienic 
conditions and meeting the different symptoms as they arise. 

Antimonial preparations are used almost exclusively as 
emetics and expectorants. Nowadays, they are employed even 
for these purposes much less than formerly, because there are 
other less poisonous expectorants and emetics. Some of the 
organic preparations of antimony are used against the various 
trypanosomatous diseases. 



276 INORGANIC DRUGS. 

MATERIA MEDICA. 

Arseni Trioxidi (U.S. P.), Acidum Arseniosum (B.P.), heavy, opaque, 
white powder, or irregular masses, either amorphous or crystalline, soluble 
in 80 parts of cold water and 15 parts of hot water. Dose: — Br. (eV-yV 
grain). Average (U.S. P.), 0.002 G. 

Liquor Potassii Arsenitis (U.S. P.), Liquor Arsenicalis (B.P.), 1 per 
cent, solution of potassium arsenite. Dose: — 0.1 too.5c.c. Br. (1-8 ng). 
Average (U.S.P.), 0.2 c.c. 

Antimonii et Potassii Tartras (U.S. P.), Antimonium Tartratum 
(B.P.), or tartar emetic, colorless, transparent crystals which become 
opaque in the air and have a sweet metallic taste. Soluble in 17 parts of 
water, insoluble in alcohol. Dose: — 0.1 to 0.2 G. Br. emetic {}4~2 
grains). Average (U.S. P.), emetic 0.3 G. ; expectorant 0.005 G. 

Antimonium Sulphuratum (B.P.), or Kermes mineral. A reddish 
white powder, insoluble in water and alcohol. Dose: — 0.01 to 0.05 G. 
Br. (1-5 grains). 

Salvarsan (dioxydiamidoarsenobenzol) is a light yellow powder kept in 
sealed glass capsules free from air, but containing the vapors of methyl 
alcohol to preserve it from oxidation. It is an acid body combining readily 
with alkalies. It is freely soluble in water, but is precipitated out by alkalies 
in small and redissolved by larger amounts. Dose : — 0.3-1.0 G. 



INDEX. 



Absinth, oil of, 1 54 

Absorption, 5 

Acacia, 186 

Acetanilid, Group of, 120, 122 

Acetanilid, 120, 122 

Acetic acid, glacial, 91, 203, 206 

Acetphenetidin, 132 

Acids, Group of, 202 

inorganic, 182 

intoxication, 184 

organic, 205 
Aconite, 91 
Aconitine series, 89 
Aconitine, Group of, 90 
Aconitine, 90 
Aconitum, 91 
Action, definition of, 3 

local, 4 

general, 4 
Actol, 263 
Adalin, 22 
Adeps, 188 
Adonidin, 115 
Adonis, 115 

Adrenalin, Group of, 142 
Adrenalin, 142 
iEther, 11, 35 
Agar-agar, 187 
Agaric Acid, Group of, 72 
Agaric acid, 72 
Agaricin, 73 
Agaricus muscarius, 78 
Albaspidin, 182 
Alcohol, 23, 29, 36 
Aldehyde, formic, 9 
Alkalies, Group of, 208 
Alkali sulphides, 237 
Almond, bitter, 64 
Almond oil, 187 
Aloes, 167, 169 
Aloin Division, 167 
Aloin, 167 



Althaea, 186 

Alum, 242 

Alumen, 242 

Aluminum, Group of, 241 

Aluminum, 241 

Alumnol, 243 

Alypin, 84 

Ammonia, Group of, 47 

Ammonia, 47, 160 

Ammoniated mercury, 259 

Ammonium compounds, 225 

benzoate, 136 

bromide, 232 

carbonate, 49 

chloride, 50 
Amygdala amara, 65 

dulcis, 187 
Amygdalin, 65 
Amyl nitrite, Group of, 36 
Amyl nitrite, 36, $8 
Amylene hydrate, 21 
Anaesthesia, general, 29, 31 

infiltration, 85 

intramuscular, ^3 

intraspinal or (Biers'), 85 

intratracheal, 32 

intravenous, 32 

local, 85 

practical, 30 

rectal, 32 

surgical, 13 
Anaesthesin, 84 
Anaesthetics, general, 9, 35 
Anaesthetics, mixtures of, 17 
Analgen, 124 
Anamirata, 55 
Anaphylaxis, 148 
Andira araroba, 137 
Angostura bark, 174 
Anhalonium, 47 
Aniline, 123, 131 
Animal extracts, 146 



277 



278 



INDEX. 



Anthelmintics, 179 

Anthracene derivatives, 167 

Anthrasol, 137 

Antiarin, 115 

Antiaris, 115 

Antifebrine, 131 

Antihydrotic, 73 

Antimonial compounds, 273 

Antimony, Group of, 266 

Antipyretics, 121 

Antipyrin, 124 

Antisepsine, 132 

Antiseptics, 127 

Antithermin, 124 

Antithyroid serum, 149 

Antitoxines, 147 

Apalachian tea, 58 

Apocynein, 115 

Apocynin, 115 

Apocynum, 115 

Apomorphine, Group of, 98 

Apomorphine, 99 

Aqua tofana, 266 

Aquae rosae, 189 

Arctostaphylos uva ursi, 163 

Argentamine, 263 

Argonin, 263 

Argyria, 260 

Argyrol, 262, 263 

Aristolochia, 174 

Aristolochine, 174 

Aristoquinine, 120 

Arnica, 153^ 

Aromatic bitters, 173 

Arsacetin, 272, 275 

Arsenic, Group of, 266 

Arsenic, 266, 274 

Arsenic, organic preparations, 270 

Arsenious acid, 267 

Arsenuretted hydrogen, 273 

Artemisia, 186 

Artificial Foods, 150 

Asagraea, 96 

Asaprol, 136 

Aseptol, 134 

Aspidin, 182 

Aspidinin, 182 

Aspidium, 181 

Aspidosamine, 99 

Aspidosperma, 104 

Aspidospermatine, 100 

Aspidospermine, 100 



Aspirin, 126 

Astringents, Group of Vegetable, 

i75 
Atoxyl, 271, 275 
Atropa, 71 
Atropamine, 71 
Atropine, Group of, 67 
Atropine, 67 
Atroscine, 71 
Auri chloridum, 263 



Barium salts, 224 

Barosma, 163 

Baths, 201 

Bay, oil of, 189 

Bay rum, 189 

Bayberry, 186 

Bearberry, 163 

Belladonine, 71 

Belladonna, 71 

Benzaconine, 91 

Benzanilid, 123 

Benzoates, 136 

Benzoic acid, 127, 130, 131 

Benzoinated lard, 188 

Benzosol, 135 

Benzoyl acetyl peroxide, 193 

Berberine, 172 

Beryllium, 242 

Beta-Eucaine, 84 

Bhang, 43 

Bicarbonates, 209 

Bile, Group of, 140 

Bile, 140 

Bismuth, Group of, 246 

Bismuth, 246 

naphtholate, 249 

salicylate, 249 

salts, 249 

subcarbonate, 249 

subnitrate, 249 
Bitters, Group of, 172 
Bitters, 172 
Bitters, aromatic, 173 
Black draught, 170 
Black wash, 259 
Blaud's pills, 266 
Blue ointment, 258 
Boletus laricis, 73 
Bone marrow, extracts, 147 
Boracic acid, 208 



INDEX. 



279 



Borates, 226 
Borax, 213 
Boric acid, 207 
Borneol, 57 
Bornyval, 22 
Brandy, 36 
Brayera, 185 

Bromide of potassium, 232 
Bromides, 226, 231 
Bromine, 196, 199 
Bromism, 228 
Bromum, 199 
Bromural, 22 
Broom, 115 
Brovalol, 22 
Brucine, 52 
Buchu, 160 
Bufonin, 113 
Bufotalin, 113 
Butyl chloral, 36 
hydras, 36 



Cacao, 58 

Cacodylates, 267, 270 

Cadmium, salts, 245 

Caesium, salts, 224 

Caffeine, Group of, 58 

Caffeine, 58 

Cajaput, oil of, 153 

Calabar bean, 82 

Calabarine, 50 

Calamine, 174 

Calamus, 174 

Calcis, liquor, 213 

Calcis, linimentum, 187 

Calcium, 223 

Calcium bromide, 232 
carbonate, 213 
hydrate, 213 
hypochlorite, 199 
oxide, 208 
phosphate, 231 
sulphide, 239 

Calomel, 258 

Calumba, 174 

Calumbin, 174 

Calx, 213 

Calx chlorinata, 199 

Calx sulphurata, 239 

Camboge, 169 

Cambogia, 172 



Camphor, Group of, 55 

Camphor, 55 

Camphor monobromate, 57 

Camphoric acid, 57 

Camphoroxim, 57 

Canadian hemp, 115 

Canadine, 172 

Cane sugar, 189 

Cannabinol, 43 

Cannabis Indica, 46 

Cantharides, 157 

Cantharidin, Group of, 155 

Cantharidin, 155 

Cantharis, 158 

Caoutchouc, 188 

Capsaicin, 156 

Capsicum, 157 

Caramel, 186 

Carbo, 188 

Carbolic acid, 127, 131 

Carbonates, 209 

Carbonic acid, 206 

Carbon monoxide, Group of, 65 

Carbon monoxide, 65 

Cardamom, 173 

Cardol, 157 

Carron oil, 187 

Cascara, 167, 169 

Cassia angustifoHa, 170 

Castor oil Division, 166 

Castor oil, 166, 169 

Catechu, 178 

Cathartics, 163 

Cathartics, saline, 216 

Cathartin, 167 

Caustic, lunar, 262 

Caustic potash, 212 

Caustic soda, 212 

Cephaline, 99 

Cephaelis, 104 

Ceratum, 188 

Cerebro-spinal meningitis serum, 149 

Cetaceum, 188 

Cetraria, 174 

Cetraric acid, 174 

Cetrarin, 174 

Cevadilline, 96 

Cevadine, 96 

Chalk, 213 

Charcoal, 188 

Chaulmoogra oil, 187 

Chenopodium, 186 



280 



INDEX. 



Cherry, wild, 65 
Chili saltpeter, 232 
Chinosol, 133 
Chinotropin, 162 
Chirata, 174 
Chiratin, 174 
Chloral, Group of, 9 
Chloral, 18, 27 
Chloralformamide, 20 
Chloralose, 20 
Chloralum hydratum, 36 
Chlorates, 225 
Chloretone, 20 
Chloride of lime, 199 
Chlorinated lime, 199 
Chlorinated soda, 199 
Chlorine, 196, 199 
Chloroform, 15 
Chloroformum, 35 
Chlorum, 199 
Cholagogues, 163 
Cholin, 49 
Chondrus, 186 
Chromic acid, 194, 195 
Chromium, 194 
Chrysarobin, 137 
Chrysophanic acid, 164, 167 
Cicuta, 54 
Cicutoxin, 54 
Cimicifuga, 174 
Cinchona, 119 
Cinchonidine, 118 
Cinchonine, 118 
Cinnamomum camphora, 58 
Cinnamon, 173 
Citrarin, 160, 162 
Citric acid, 206 
Citrullus colocynthis, 171 
Claviceps purpurea, 109 
Coal-tar derivatives, 120 
Cobalt, 265 
Coca, 86 

Cocaine, Group of, 82 
Cocaine, 82 
Cocoa, 58 
Cocoa butter, 187 
Codeine, 42 
Coffee, 58 
Colchiceine, 98 
Colchicine, Group of, 97 
Colchicine, 97 
Colchicum, 98 



Collodion, 186 
Colocynth, 164, 169 
Colocynthin, 168 
Columba, 174 
Common salt, 217 
Compounds of heavy metals, 240 
Condurango, 173 
Coniine, Group of, 92 
Coniine, 92 
Conium, 94 
Convallamarin, 113 
Convallaria, 115 
Convolvulin, 168 
Convolvulus, 171 
Copaiba, Group of, 159 
Copaiba, oil of, 159, 161 
Copper, Group of, 243 
Copper sulphate, 245 
Coriamyrtin, 54 
Cormine, 174 
Cormus, 174 
Corrosive sublimate, 258 
Cotarnine, 109 
Coto, 174 
Cotoin, 174 
Cotton, 186 
Cotton-seed oil, 187 
Counter-irritation, 151 
Creolin, 129, 131 
Creosol, 135 
Creosotal, 135 
Creosote, 127, 129 
Cresol, 135 
Creta, 213 
Croton-chloral, 36 
Croton-oil, 166, 169 
Crotonoleic acid, 166 
Crurin purum, 133 
Cubeb, Group of, 159 
Cubeb, oil of, 153, 159, 161 
Cubebin, 163 
Cucumber, squirting, 171 
Cucurbita, 183 
Curare, Group of, 86 
Curare, 86 
Curarine, 87 
Curin, 88 
Cusparia, 174 
Cusparine, 174 
Cusso, 182 
Cyanides, simple, 64 
Cyclamen, 1 00 



INDEX. 



28l 



Dandelion, 174 

Daphne mezereum, 159 

Datura, 71 

Daturine, 71 

Delphinine, 91 

Delphinium, 91 

Dermatol, 249 

Diastase, 140 

Digalen, 114 

Digestive ferments, Group of, 139 

Digipuratum, 114 

Digitalein, 109 

Digitalin, 109 

Digitaliresin, 54 

Digitalis, 109 

Digitonin, 114 

Digitophyllin, 114 

Digitoxin, Group of, 109 

Digitoxin, 109 

Dimethylethyl carbinol, 21 

Dionine, 43 

Dioxycolchicin, 98 

Diphtheria antitoxine, 148 

Disinfectants, 121 

Diuretin, 62 

Dogwood, poison, 141 

Dormiol, 20, 22 

Dover's powder, 45 

Drastics, 169 

Drug, definition of, 3 

Dryopteris filix-mas, 181 

Duboisia Hopwoodii, 79 

Duboisia myoporoides, 72 

Duotal, 135 



Ecb allium, 171 
Ecgonine, 86 
Elastica, 188 
Elaterin Division, 168 
Elaterin, 168 
Elaterium, 171 
Emetics, 99 

Emetine, Group of, 98 
Emetine, 99 
Emodin, 164, 167 
Emulsin, 65 
Enzymes, 140 
Epicarin, 136 
Epinephrin, 115 
Epsom salt, 233 
Ergot, 105 



Ergotinic acid, 106 
Ergotoxine, Group of, 105 
Erythrophlein, 113 
Erythrophlceum, 115 
Eseridine, 79 
Eserine, 79 
Ether, Group of, 9 
Ether, n 
Ethyl alcohol, 22 

bromide, 16, t,^ 

carbamate, 21, 28, 36 

chloride, 17, 34 

nitrite, 38 
Ethylene bromide, 16 
Eucaine, 86 
Eucalyptol, 158 
Eucalyptus, 153 
Eugallol, 135 
Euonymin, 171 
Euonymus, 171 
Euphorbin, 156 
Euquinine, 120 
Europhen, 135 
Exalgine, 123 
Excretion, 6 
Exodin, 171 
Exophthalmic Goitre, 150 



Fats, 186 

Fel bovis, 141 

Ferments, digestive, Group of, 139 

Ferratin, 266 

Filicic acid, 182 

Filicin, 182 

Fluorides, 226 

Formaldehyde, 160 

Formaline, 163 

Foxglove, 109 

Frangula, 167 

Frangulin, 167 

Free halogens, 191 



Galla, 178 
Gallic acid, 178 
Gamboge, 172 
Gaultheriae, 133 
Gelsemine, 50, 52, 92 
Gelseminine, 92 
Gelsemium, 93 



2&2 



INDEX. 



Genitourinary disinfectants, 159 

Gentian, 174 

Genticin, 174 

Gentiopicrin, 174 

Ginger, 173 

Glauber's salt, 232 

Glycerin, 188 

Goa powder, 137 

Gold, Group of, 260 

Gold, 261 

Gonolobus, 173 

Gossypium, 187 

Goulard's extract, 254 

Gout remedies, 161 

Guaiacol, 135 

Guarana, 58, 62 

Gum arabic, 187 

Gun cotton, 188 

Gutta percha, 186 

Gynoval, 22 



Haematoxylon, 179 

Halogens, free, Group of, 196 

Hamamelis, 179 

Hashish, 43 

Hedonal, 22 

Hellebore, green, white, 96 

Helleborin, 113 

Helleborus, 115 

Helmitol, 160, 162 

Helvellic acid, 10 1 

Hemlock, 94 

Henbane, 71 

Heroine, 43 

Hetralin, 162 

Hexamethylenamine, Group of, 160 

Hexamethylenamine, 160, 162 

Holocain, 84 

Homatropine, 69 

Honey, 186 

Honthin, 177 

Hops, 174 

Hormonal, 146 

Hormones, 146 

Humulus, 174 

Hydrargyrum, 258 

Hydrastine, Subgroup of, 107 

Hydrastine, 107 

Hydrastinine, 107 

Hydrastis, 107 

Hydrochloric acid, 202, 206 



Hydrocyanic acid, Group of, 62 
Hydrocyanic acid, 62 
Hydrogen peroxide, 193, 195 

sulphide, 237 
Hyoscine, 69 
Hyoscyamine, 67, 69 
Hyoscyamus, 71 
Hypnal, 20 
Hypnotics, 9 



Iceland moss, 174 

Ichthalbin, 137 

Ichthyocolla, 186 

Ichthyol, 127, 130 

Idiosyncrasies, 5 

Ignatia, 50 

Inorganic drugs, 191 

Iodides, 228, 230 

Iodine, 196, 199 

Iodipin, 200 

Iodism, 198, 229 

Iodoform, 200 

Iodol, 136 

Iodothyrin, Group of, 144 

Iodothyrin, 144 

Iodum, 199 

Ions, 215 

Ipecac, 103 

Ipecacuanha, 104 

Irish moss, 187 

Iron, Group of, 263 

Iron, 263 

Iron chloride, 265 

Iron sulphate, 265 

Isopral, 20, 22, 28 

Itrol, 262 

Ivy poisoning, 156 



Jaborandi leaves, 73 
Jalap, 169 
Jalapin, 168 
Japaconitine, 91 
Jateorrhiza, 174 
Jervine, 96 
Juniper, 153, 1 59 



Kairin, 124 
Kairolin, 124 
Kamala, 183 



INDEX. 



283 



Kaolin, 189 
Kaschew, 155 
Kermes mineral, 276 
Ketones, 9 
Kino, 179 

Kino-tannic acid, 179 
Kola, 58 
Kossin, 185 
Kosso, 182 
Kossotoxin, 182 
Krameria, 178 

Labarraque's solution, 199 
Lactic acid, 203 
Lactophenin, 123 
Lactose, 186 
Lactucarium, 44 
Lard, 188 
Largin, 263 
Laudanum, 46 
Lead, Group of, 250 
Lead, 250 

acetate, 253 

iodide, 254 

subacetate, 254 
Lead palsy, 253 
Lenigallol, 135 
Lettuce, 44 
Lichenin, 174 
Lily of the valley, 115 
Lime, 213 
Linseed oil, 187 
Liquorice, 170 
Litharge, 253 
Lithium salts, 224 

benzoas, 136 

salicylate, 133 
Liver of sulphur, 239 
Lobelia, 94 
Lobeline, 92 
Logwood, 179 
Lugol's solution, 199 
Lupulin, 174 
Lupulinic acid, 172 
Lupulus, 174 
Lycetol, 161 
Lycopodium, 189 
Lysidine, 161 
Lysol, 129, 131 

Magnesia, 224 
Magnesium salts, 224 



Magnesium carbonate, 209 

oxide, 210, 212 

peroxide, 193 

sulphate, 229 
Malakin, 126 
Male fern, 179, 185 
Malt extracts, alcoholic, 140 
Manganese, 264 
Marshmallow, 186 
Mate, 58 

Materia medica, definition of, 6 
Mechanical Agents, Group of, 186 
Mel, 189 
Mellisa, 186, 189 
Menthol, 57 
Menthol iodol, 136 
Mercurialism, 257 
Mercury, Group of, 254 
Mercury, 254 
Mescale, 44 
Mesotan, 134 
Metals, heavy, 240 
Methacetine, 123 
Methyl alcohol, 26 
Methyl salicylate, 126 
Mezerein, 156 
Mineral acids, 206 
Mineral waters, 201 
Molybden, 242 
Monobromated camphor, 58 
Morphine, Group of, 40 
Morphine, 40 
Morphinism, 42 
Mulberry juice, 186 
Muscaridine, 75 
Muscarine, Group of, 73 
Muscarine, 73 
Mustard, 157 

Mustard oil, Group of, 154 
Mustard, oil of black, 155 
Mustard plasters, 155 
My rosin, 158 
Myrrh, 157 



Naphthalene, 127 
Naphtol, 130, 136 
Narcosis, 9 
Neriin, 115 
Neriodorin, 115 
Nerium, 115 



INDEX. 



Neuronal, 22, 28 

Neutral salts, Group of, 214 

Nickel, 265 

Nicotina, 79 

Nicotine, 73, 75 

Nigella, 79 

Nigelline, 79 

Nightshade, deadly, 71 

Nitrates, 226 

Nitric acid, 202, 206 

Nitrites, inorganic, 38 

Nitroglycerine, 38 

Nitrous oxide, 17, 34 

Novaspirin, 126 

Novocain, 84 

Nux vomica, 50, 53 



Oak, 176 
Oils, 186 

essential, 153 

purgative, 166 
Oleander, 115 
Oleandresin, 54 
Olive oil, 187 
Ophelic acid, 174 
Opium, 46 
Orange, bitter, 173 
Ordeal bean, 82 
Orexine, 175 
Organic acids, 205 
Organotherapeutics, 139 
Orthoform, 84 
Ortho-phosphate, 225 
Osmic acid, 261 
Osmium, 261 
Ovarian extract, 146 
Oxidizing agents, 191 
Oxydimorphine, 41 
Oxygens, Group of, 192, 194 
Oxygen, 192 
Ozone, 192 



Pancreas, extract of, 140 
Pancreatin, 139 
Papain, 140 

Papaver somniferum, 46 
Papayotin, 140 
Paraldehyde, 21, 28 
Paraldehydum, 36 
Paregoric, 46 



Parillin, 104 

Paullinia, 58 

Pelletierine, Group of, 180 

Pelletierine, 181, 184 

Pellotin, 44 

Pental, 17 

Pentalum, 35 

Pepo, 183 

Pepper, 157 

Pepper, Cayenne, 155 

Pepsin, 139 

Peronin, 43 

Peroxide of hydrogen, 193 

Pharmacodynamics, 4 

Pharmacognosy, 6 

Pharmacological action, 3 

Pharmacology, definition of, 4 

Pharmacopeia, 6 

Pharmacy, 6 

Phenacetine, 123 

Phenol, Group of, 120 

division, 127 
Phenol, 127 

Phenolphthalein Division, 167 
Phenolphthalein, 167 
Phenol sulphonates, 134 
Phenozonum, 132 
Phenyl salicylate, 126 
Phenylhydrazine, 124 

derivatives, 124 
Phosphates, 209 
Phosphorated oil, 237 
Phosphoric acid, 202 
Phosphorus, Group of, 233 
Phosphorus, yellow, 233 
Phosphuretted hydrogen, 236 
Physostigma, 82 
Physostigmine, Group of, 79 
Physostigmine, 79 
Picis liquidae, oleum, 137 
Picrasma, 173 
Picropodophyllin, 169 
Picropodophyllotoxine, 168 
Picrotoxin, Group of, 54 
Picrotoxin, 54 
Pilocarpidine, 73, 75 
Pilocarpine, Group of, 73, 75 
Pilocarpine, 73, 75 
Pilocarpus, 78 
Piperazine, 161 
Piscidia, 45 
Pituitary extract, 147 



INDEX. 



28< 



Piturine, 79 
Platinum, 261 
Podophyllin, Division, 168 
Podophyllotoxin, 168 
Podophyllum, 171 
Poison ivy, 155, 156 
Poison oak, 155 
Pomegranate, 179 
Posology, 6 
Potash, 208 
Potassa, 208 
Potassa sulphurata, 239 
Potassium action, 223 

acetate, 212 

bicarbonate, 212 

bichromate, 194 

bitartrate, 171 

bromide, 232 

carbonate, 212 

chlorate, 231 

chloride, 231 

citrate, 212 

hydrate, 208 

iodide, 231 

nitrate, 231 

permanganate, 193, 195 

salts, 223 

sulphide, 239 
Protargol, 262 
Protocurarin, 88 
Protocurin, 88 
Protoveratrine, 96 
Prunus, 65 
Prussic acid, 62 
Pseudoaconitine, 91 
Pseudojervine, 96 
Pseudoveratrine, 96 
Punica, 185 
Purgatine, 168 
Purgatives, oily, 166 

saline, 214 

vegetable, 163 
Pyramidon, 124 
Pyrocatechin, 128 
Pyridin, 136 
Pyrodine, 124 
Pyrogallic acid, 129 
Pyrogallol, 129 
Pyroxylinum, 188 

Quassia, 173 
Quassin, 173 



Quebrachine, 99 
Quebracho, 99 
Quebracho alkaloids, 100 
Quercin, 178 
Quercitannic acid, 178 
Quercus, 178 
Quicksilver, 254 
Quillaja, 100 
Quinic acid, 161 
Quinine, Group of, 116 
Quinine, 116 
Quinoline, 124 



Raspberries, 186 
Resins, 160 
Resopyrine, 124 
Resorcine, 129 
Resorcinol, 134 
Rhubarb Division, 167 
Rhubarb, 167, 169 
Rhus glabra, 179 
Ricin, 166 
Ricinol, 166 
Ricinus, 170 
Rochelle salt, 233 
Rose, 186 
Rose, oil of, 189 
Rosin, 158 
Rubidium salts, 224 
Rubus, 179 



Sabadilla, 96 

Sabadilline, 96 

Sabine, 153, 157 

Saccharin, 186 

Saccharum, 189 

Saffron, 186 

Salamander, alkaloids of, 54 

Salicin, 126 

Salicylates, 125 

Salicylic acid, 125, 131 

Saliformin, 162 

Saline cathartics, 214 

Salipyrine, 124 

Salocoll, 126 

Salocreol, 126 

Salol, 126 

Salophen, 126 

Salt action, 191, 214 



286 



INDEX. 



Saltpeter, 232 

Salts, general action, 216 

Salvarsan, 272, 275 

Samandarine, 54, 55 

Sandalwood, 159, 161 

Sandalwood oil, Group of, 159 

Santonica, 179 

Santonin, Group of, 183 

Santonin, 185 

Sapo, 187 

Saponaria, 100 

Saponin, 100 

Sapotoxin, Subgroup of, 100 

Sapotoxins, 100 

Sarsae radix, 100 

Sarsaparilla, 100 

Scammonin, 168 

Schleich's infiltration anaesthesia, 85 

Scilla, 115 

Scillain, 113 

Scoparin, 94 

Scopolamine, 67, 69 

Scopolia, 72 

Seidlitz powder, 233 

Selenium, 248 

Senega, 100 

Senegin, 105 

Senna, 167, 169 

Sepsin, 102 

Serpentaria, 174 

Serum, spinal meningitis, 149 

Sidonal, 161 

Silver, Group of, 260 

Silver, 260 

Silver nitrate, 262 

Sinalbin, 158 

Sinapin, 158 

Sinapis, 158 

Sinigrin, 158 

Skin irritants, Group of, 151 

Slippery elm, 187 

Smoking, 77 

Snake-venom antitoxines, 149 

Soap, 187, 212 

Soda, 208 

chlorinated, 199 
Sodium acetate, 213 

benzoate, 136 

bicarbonate, 209 

borate, 213 

bromide, 232 

carbonate, 209 



Sodium chlorid, Group, 23c 
Sodium chloride, 217, 222, 229 

hydrate, 208 

hypochlorite, 199 

iodide, 232 

nitrate, 232 

nitrite, $8 

peroxide, 193 
Sodium salicylate, 125 
Sodium sulphate, Group, 230 
Sodium sulphate, 229 
Solanaceae, alkaloids, 67 
Solanine, Group of, 100 
Solanine, 100, 101 
Somnal, 20 
Soporifics, 9 
Spanish flies, 155 
Sparteine, Group of, 92 
Sparteine, 92 
Spartium, 94 
Spermaceti, 188 
Spigelia, 184 
Spiritus frumenti, 36 

gaultheriae, 133 

vini gallici, 36 
Spleen, extract of, 147 
Squills, 155 

Squirting cucumber, 171 
Staphisagrine, 91 
Starch, 189 
Stearoptenes, 57 
Stovain, 84 
Stramonium, 71 
Strontium bromide, 232 
Strontium, salts, 224 
Strophanthin, 112 
Strophanthus, 115 
Strychnine, Group of, 50 
Strychnine, 50, 53 
Strychnos, 50 
Stypticine, 109 
Subcutin, 84 

Sublimate, corrosive, 258 
Sugar, 186 
Sulphate ions, 225 
Sulphides, Group of, 237 
Sulphites, 225 
Sulphonal, 20, 28 
Sulphonethylmethane, 21 
Sulphonmethane, 20 
Sulphur, Group of, 237 
Sulphur, 237 



INDEX. 



287 



Sulphuretted hydrogen, 237 
Sulphuric acid, 202 
Sulphuris, hepar, 239 
Sumach, 179 

Suprarenal gland, extract of, 143 
Suprarenin, 144 



Taka-diastase, 140 
Talc, 189 
Tannalbin, 177 
Tannic acid, Group of, 175 
Tannic acid, 175 
Tannigen, 177 
Tannocoll, 177 
Tannoform, 178 
Tannopin, 177 
Tar, 130 
Taraxacein, 174 
Taraxacin, 174 
Taraxacum, 174 
Tartar, cream of, 233 
Tartaric acid, 208 
Tea, 58 
Tellurates, 248 
Tellurium, 248 
Terebene, 158 
Terebinthina, 158 
Terpenes, 153 
Terpin hydrate, 158 
Testicle, extract of, 146 
Tetano-cannabine, 50 
Tetanus antitoxine, 149 
Tetronal, 21, 28 
Thalline, 124 
Thallium, salts, 253 
Thebaine, 50, 52 
Theobroma, 62 
Theobromine, 60 
Theophyllin, 61 
Therapeutics, definition of, 3 
Thermifugine, 124 
Thevetia, 115 
Thevetin, 115 
Thiolum, 137 
Thiosinamine, 158 
Thymol, 57, 127, 129, 131 
Thymus gland, 146 
Thyreoglobulin, 145 
Thyreoiodin, 145 
Thyroid gland, 144 
Tiglium, oil of, 171 



Tin, 242 

Tobacco, 76 

Tobacco, Indian, 94 

Toxicodendrol, 156 

Toxicology, definition of, 4 

Toxins, 147 

Toxiresin, 54 

Tragacanth, 186 

Trichloracetic acid, 203, 206 

Triferrinum, 266 

Trimethylamin, 149 

Trional, 21, 28 

Tropacocaine, 84 

Tropic acid, 72 

Tropine, 72 

Tubocurarin, 88 

Tungsten, 242 

Turpentine Oil, Group of, 153 

Turpentine, 157 

Tyramine, 105 



Ulmus, 187 

Upas tree, 115 

Ural, 20 

Uranium, 242 

Urethane, 21, 28, 36 

Urinary antiseptic, 159 

Urocol, 161 

Urol, 161 

Urosine, 161 

Urotropine, 162 

Uva ursi, 160 



Vaccination, 148 

Vaccines, 147 

Vanadium, 242 

Vanilla, 186, 189 

Vanillin, 189 

Vegetable astringents, 175 

bitters, 173 

purgatives, Group of, 163 
Veratridine, 96 
Vera trine, Group of, 94 
Veratrine, 89, 94 
Veratrum, 96 
Vermicides, 179 
Vermifuges, 180 
Veronal, 21, 28 
Vini gallici, spiritus, 36 
Volatile oils, 153 



288 



INDEX. 



Water, Group of, 200 
Water, 200 

distilled, 200 
Waters, mineral, 201 
Whiskey, 36 
Wintergreen, oil of, 133 
Witch-hazel, 179 
Worm remedies, 179 

Xanthin, 60 



Yellow wash, 259 
Yobimbin, 84 



Zinc chloride, 245 
Zinc, Group of, 243 
Zinc peroxide, 193 
Zinc sulphate, 245 
Zinci phenolsulphonas, 134 
Zincum, 243 



AUG 9 1912 



LIBRARY OF CONGRESS 




000EE3A71001 



